North Carolina Community and State Chief Medical Officer

About the position

The Chief Medical Officer (CMO) for the Community and State (C&S) Plan at UnitedHealthcare is a pivotal role responsible for overseeing the clinical operations and ensuring the delivery of high-quality healthcare services to members. This position is accountable for the implementation and management of initiatives aimed at achieving clinical excellence, improving quality ratings, and ensuring appropriate utilization of inpatient and outpatient services. The CMO will work closely with various stakeholders, including the local health plan, United Clinical Services (UCS), and other regional partners, to drive health system transformation and compliance with mandated provisions. The CMO will report directly to the local C&S plan President and will have a dotted line relationship with the C&S Chief Medical Officer and UCS market-assigned Regional Chief Medical Officer. In this role, the CMO will focus on several key areas, including quality and affordability, clinical excellence, relationship equity, state compliance, innovation, growth, and focused improvement. The CMO will be responsible for Total Medical PMPM performance and targets, collaborating with UCS clinical operations teams, and leading healthcare affordability initiatives. The CMO will also support quality initiatives, oversee the peer review process, and maintain compliance with government mandates. Additionally, the CMO will drive innovation in clinical practices and care management programs, ensuring that the health plan meets its growth objectives while delivering value to members. The CMO will play a critical role in fostering relationships with network and community physicians, engaging with external constituents, and representing the local C&S plan at state hearings. This position requires a strong leader who can inspire teams, drive change, and effectively communicate with various stakeholders. The CMO will also be expected to mentor and develop staff, ensuring that the team is aligned with the company's mission and strategic goals. Overall, the CMO will be instrumental in shaping the future of healthcare delivery within the C&S plan, making a significant impact on the health and well-being of the communities served.

Responsibilities
? Ensure accountability for Total Medical PMPM performance and targets for the local C&S plan.
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? Conduct hospital Joint Operations Committee meetings with Network and contribute to regional Medical Cost Operating Team (MCOT) decisions.
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? Share data with physicians and physician groups on quality and efficiency improvement opportunities.
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? Implement local Health Care Affordability Initiatives and oversee new clinical model operations.
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? Support UHN initiatives and Quality Affordability Programs to achieve inpatient and outpatient utilization goals.
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? Oversee the C&S market peer review process as defined by State regulators and participate in the Peer Review committee.
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? Support HEDIS data collection, STARs clinical collection, CAHPS improvement, and drive Health Plan accreditation activities.
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? Maintain knowledge of government mandates and provisions for the local C&S market and implement compliant clinical programs.
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? Lead the clinical interface with care providers and UHC network management to transform the health system.
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? Deliver the clinical value proposition focused on quality, affordability, and service in support of growth activities.
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? Identify opportunities for focused improvement through participation in regional and local Medical Cost Operating Teams.
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? Maintain an active liaison with UCS Grievance and Appeals and represent the Local C&S plan at State Fair Hearings.

Requirements
? Active/unrestricted North Carolina Medical License
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? Active/unrestricted Board Certification in internal medicine, family medicine, pediatrics, psychiatry, OB/GYN and/or emergency medicine
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? 5+ years of clinical practice experience
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? Experience in Value Based Contracting / Risk contracting
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? Solid knowledge of managed care industry and the Medicaid line of business
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? Familiarity with current medical issues and practices
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? Proficiency with Microsoft Office applications
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? Proven ability to develop relationships with network and community physicians and other providers
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? Proven ability to focus on key metrics
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? Proven superior presentation skills for both clinical and non-clinical audiences
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? Demonstrated excellent project management skills
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? Proven solid data analysis and interpretation skills
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? Demonstrated negotiation and conflict management skills
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? Resides in North Carolina and available for routine, in-person contact with market-teams, network providers, stakeholders, and regulators

Nice-to-haves
? Demonstrated experience with behavioral health delivery, SUD treatment, child welfare, pharmacy management and related regulatory areas
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? Experience with UHC and/or Optum clinical operations and medical leadership
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? Demonstrated knowledge and professional experience with Medicaid managed care

Benefits
? Flexible work options including remote work
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? Opportunities for professional development and career growth
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? Comprehensive health insurance coverage
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? Retirement savings plan options
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? Paid time off and holidays
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? Employee assistance programs
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? Diversity and inclusion initiatives

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