Empire Plan Chief Medical Officer – NYC, Long Island, Albany preferred
The Empire Plan Chief Medical Officer (CMO) is the senior clinical executive for the Empire Plan medical program and future integrated plan components; including the hospital component, behavioral component and potentially any Medicare & Retirement (M&R) component. The CMO has accountability for driving excellent results for all clinical affordability, quality, population health, growth, Net Promoter Score (NPS), and external relationship initiatives for the designated market.
The CMO is the leader of the market level Continuum of Care (COC) ensuring integration of all United Healthcare (UHC), United Clinical Services (UCS) and OPTUM clinical functions to drive incremental reduction in admissions/ readmissions, continuous improvement of HEDIS and STARs ratings, reduction of unnecessary ER visits, and mitigation of provider abrasion from prior authorization and inpatient management programs.
The CMO collaborates with the Empire Plan VP of Client Management, Executive Director of Network Contracting as well as the market Senior Leadership (SLT) team, UCS staff, and matrix partners such as Network, Sales and other market and regional partners to implement and drive programs to support the Empire Plan contract and client goals. The CMO reports to the Empire Plan VP of Client Management with dotted line accountability Chief Medical officer of the Employer and Individual business segment.
The Empire Plan CMO performs as an integral part of the Account Management and Empire Client Management team. The CMO utilizes HPM, biometric data, Case Management program detail, and other tools to provide individualized analysis of existing clients' utilization trends and future risk and provides strategic advice on selection and deployment of Optum clinical programs, integration strategies with external vendors, and relevant benefit design issues to achieve client's goals. The CMO is critical to finalist meetings, details our clinical value proposition incorporating relevant programs across Optum and UHC and provides necessary specifics on the design, performance, and comparisons to market competitors. The CMO applies critical listening skills to adapt presentations to Empire needs
The CMO provides advice on managing health threats (e.g. COVID), on referrals typically for C-Suite members, as well as advice on benefit design issues. The CMO also intervenes in individual cases to ensure effective management and the expected benefit design performance.
The CMO is prepared to deliver as requested presentations to benefit staff, customer employee populations, union leaders, and others on clinical programs, market trends, clinical benefit issues and other selected topics. The CMO is capable of effectively engaging with senior executives on the above issues as required. The CMO actively participates in the design of innovative clinical programs where unmet Empire needs are identified. The CMO may represent UHC E&I on the national boards and committees of customer led organizations (PBGH, NBGH, HRC, American Benefits Council, etc.)
•Identify customer clinical program needs and gaps -Provide clinical leadership to account teams, client management, and directly to large customers
•Responsible for clinical strategy and performance of clinical programs at customer level
•Provide clinical and customer input into design of clinical innovations
•Provide clinical support to customers at the senior benefits manager level
•Develops broad understanding of both industry and purchaser trends in healthcare benefits delivery
•Maintains current knowledge of utilization and practice trends across industry
•Advises large customers on benefit design, clinical program strategy, pilots and other interventions
•Remains current on business environment and implications for each customer supported
•Provide market leadership to broad swath of purchasers through participation in national and regional customer organizations in order to enhance reputation of UHC and to deliver differentiation story
Present convincingly to multiple constituents including bargained populations, senior executives, benefit operations managers, members, and physicians
-MD or DO degree
-Active unrestricted New York physician state license
-Current board certification in ABMS or AOA specialty
-10+ years of clinical practice experience post residency
-Strong understanding of and concurrence with evidence-based medicine (EBM) and managed care principles, as well as familiarity with current medical issues and practices
-Foundational windows based computer skills, including typing, word processing, presentation, and spreadsheet applications, as well as internet research skills.
-Professionally-appropriate written vocabulary and grammar skills, including the ability to modify for different audiences
• Familiarity with current medical issues and practices
• Excellent interpersonal communication skills
• Superior presentation skills for both clinical and non-clinical audiences
• Proven ability to develop relationships with network and community physicians and other providers
• Excellent project management skills
• Solid data analysis and interpretation skills; ability to focus on key metrics
•Identify external partnerships for program innovation, development and improvement
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