UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
The Chief Medical Officer, Clinical Policy, is a thought-leader responsible developing and executing the strategic vision for UHC Clinical Policy.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Delivering high value and quality for customers through policies and programs to achieve:
- The Triple Aim - better care, lower cost and better clinical outcomes
- Reduction in unwarranted clinical variation
- Collaborating to align goals and strengthen partnerships across all key stakeholders:
- Internal - including UHG Medical Affairs, External Affairs, Clinical Operations, Clinical Pharmacy, Behavioral Health and all Lines of Business
- External - including regulators, governmental agencies, medical societies, health plans, academic research centers and health care technology companies
- Keeping abreast of developments at the intersection of science, technology, analytics and business to drive clinical innovation and policy transformation
- Understanding trends and customer expectations shaping the health care industry
- Leading the strategy and development of clinical policies focused on improving quality, safety, efficacy, affordability and experience of care
- Identifying opportunities and priorities through data and advanced analytics research; analyze medical and clinical evidence, scientific research and real-world outcomes to develop objective, unbiased and defensible polices in order to decrease unwarranted variation in cases and drive value for our members, providers and plan sponsors
- Working closely with the network provider strategy and relationship team to organize and support medical society engagement meetings
- Engaging to socialize policies and implement major programs
- Supporting COVID command center and related workstreams in response to pandemic and related public health issues
- Clinical lead for UnitedHealthcare laboratory program including chair LAB Scientific Advisory Board)
- Member of affordability steering committee and voting member at CPAC (Core Power Affordability Committee)
- Incorporating new care delivery models, including telehealth and virtual care into clinical policies
- Focusing on increased transparency and administrative simplification in policy development that will streamline the UM process
- Leading internal and external communication strategy for new and relevant clinical policy updates
- Leading UHC clinical content development and rules translation
The role will also include analysis and provision of clinical care guidelines including:
- Provision of access for our membership to safe and effective healthcare technologies, devices, pharmaceuticals, and services
- Review of the medical literature
- Provision of guidance of benefit and coverage interpretation
- Provision of decision support for internal clinical reviews
- Provision of a consistent, compassionate approach to the creation of policies that are compliant with legal and regulatory requirements
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- MD or DO active unencumbered medical license to practice from at least one state in the US
- Active board certification verifiable through the ABMS/AOA
- 10+ years of active medical practice experience
- 10+ years of managing a team of physicians
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
- 10+ years of health plan administration experience in medical management
- Solid strategic, leadership and operational skillset in a matrixed environment
- Experience in development, implementation and communication of clinical policies
- Strong knowledge of managed care industry and regulatory requirements
- Solid understanding of advanced analytics
- Solid understanding of medical informatics
- Experience engaging with key stakeholders in the health care industry including regulators, governmental agencies, medical societies, academic research centers and health care technology companies
- Commitment to evidence-based medicine
- Dedicated to learning about and evaluating developing therapies and technologies
- Medical coding including CPT, ICD10 and HCPS proficiency
- Excellent project management skills
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
Colorado Residents Only: The salary/hourly range for Colorado residents is $340,000 to $390,000. The role is also eligible to participate in UHG’s annual bonus and long term incentive plans. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: telecommute, remote, work from home