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The Community Plan of Idaho Chief Medical Officer (CMO) has accountability for driving clinical excellence in alignment with state regulatory requirements and state & community health priorities. The CMO will achieve this, through partnership with local health plan leaders and enterprise clinical operations, by providing oversight and guidance around quality improvement, appropriate inpatient and outpatient utilization, affordability, growth, regulatory compliance, and health system transformation. The CMO will also work with the provider network team to develop strong partnerships with local healthcare systems and providers. This position reports to the Community Plan of Idaho Chief Executive Officer and has a dotted line relationship to the UnitedHealthcare Chief Medical Officer. The CMO will also work closely with the health plan’s clinical leadership to develop and implement clinical programs for people with complex social driver of health (SDOH), medical and behavioral health needs to be empowered in their healthcare decisions.
This is a fast-paced working environment that requires the ability to multitask with attention to detail and excellent organizational skills.
If you reside in the state of Idaho, you’ll enjoy the flexibility to work remotely
- as you take on some tough challenges.
Primary Responsibilities :
Quality and Affordability – The CMO has primary responsibility and accountability for Total Medical PMPM performance and targets for the local health plan. This will require a close working relationship with clinical operations teams, Optum Behavioral Health Solutions, and other internal clinical vendors, as well as with local and national affordability teams. Activities will include responsibility to oversee collaboration with Optum and new clinical model operations as well as new Models of Care, such as those defined by CMS or the Idaho Department of Health and Welfare. Additional responsibilities include participating in hospital Joint Operations Committee meetings with prioritized providers in coordination with UnitedHealth Network (UHN), data sharing with physicians and physician groups on quality and efficiency improvement opportunities, completing peer to peer communications for quality of care as required, and implementing local and national Health Care Affordability Initiatives in order to achieve inpatient and outpatient utilization and affordability goalsClinical Excellence – The CMO provides oversight to the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, and drives health plan accreditation activities as well as quality rating improvement initiatives and other clinical interventions. The CMO is responsible for the achievement of goals for contractually required clinical Quality Performance Indicators and state regulator-driven pay-for-quality initiatives. The CMO oversees market peer review processes, including Quality of Care and Quality of Service issues, and leads the Physician Advisory Committee (PAC), Quality Management Committee (QMC) and other associated committees. The CMO is accountable for oversight of the entire clinical model. The CMO will have direct reportsRelationship Equity and State Compliance - The Health Plan CMO maintains a strong working knowledge of all Idaho government mandates and provisions related to clinical services, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. They are also committed to being effectively engaged with our external constituents such as consumers / members, physicians, medical and specialty societies, hospitals and hospital associations, federal / state regulators, and market-based collaboratives. The health plan CMO will work collaboratively in these activities with utilization management medical directors and regional CMOs. The Health Plan CMO will be the outward face to State regulators based upon Contract, and direction of Plan CEO and should provide clinical thought leadership with external entities and the stateHealth Equity – The CMO has a leadership role in helping develop a strategy to identify clinical areas where there are disparities in health outcomes across groups and developing an approach to closing gaps in health outcomes. The CMO also supports the team in maintaining Health Equity designationInnovation—The CMO leads the clinical interface with care providers and UHN colleagues in efforts to transform the health system. Primary local responsibility includes driving quality improvement and provider incentive models through identification of appropriate practices; initial contact and target setting, and implementation, as well as ongoing leadership during monthly Joint Operating Committees (JOCs). Knowledge of alternative payment model variants will be essential. Secondary responsibility will include but not limited to, UHC’s Accountable Care Platform, clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and network optimization, and consumer engagementGrowth – The CMO delivers the clinical value proposition focused on quality, affordability and service, in support of growth activities of the health plan. The CMO reviews and edits communication materials as required and represents the voice of the market-based customer in program design. The CMO contributes to any RFA activity and clinical innovations. The CMO actively promotes positive relations with State / local regulatory authorities and medical societiesFocused Improvement – The CMO is responsible for identifying opportunities through participation in regional and local market reviews, and healthcare economics analyses. They will also provide oversight of the performance of utilization management including the Inpatient Care Management team and Clinical Coverage Review team (prior authorization), Appeals and Grievances, Optum Behavioral Solutions, Optum Physical Health, OptumRx and other shared services teamsGrievances and Appeals - The CMO maintains an active liaison with UnitedHealth Appeals & Grievances team and is responsible for representing the health plan at State-level Fair HearingsYou’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.
Required Qualifications :
Idaho licensed physician active and unrestricted; Board Certified in an ABMS or AOBMS specialty5 years clinical practice experience2 years of Quality management experienceSolid knowledge of managed care industry and Medicaid / Medicare experienceUnderstanding of the LTSS populationFamiliarity with current medical issues and practices nationally and locallySolid leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organizationExperience engaging in health equity work and / or with communities that are historically underserved / underrepresented in healthcareExcellent interpersonal communication skillsSuperior presentation skills for both clinical and non-clinical audiencesProven ability to develop relationships with network and community physicians and other providersExcellent project management skillsSolid data analysis and interpretation skills; ability to focus on key metricsSolid team player and team building skillsStrategic thinking with proven ability to communicate a vision and drive resultsSolid negotiation and conflict management skillsCreative problem-solving skillsProficiency with Microsoft Office applicationsReside in IdahoPreferred Qualifications :
Bilingual – English and SpanishExperience working with Idaho Department of Health and WelfareLeadership positions in Idaho medical associations / societiesLive in the Boise areaAll employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyThe salary range for this role is $, to $, annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
