Reporting to the health plan CEO, the Chief Medical Officer is the key clinical leadership position with UnitedHealthcare Community Plan Hawaii ("UHCCP"). UHCCP Hawaii provides health care coverage for nearly 50,000 Medicaid and over 16,000 low-income Medicare individuals across the State of Hawaii. Position leads a team of over 150 clinical and support staff employees both office and field based interacting with our health plan members, providers and others. Leadership responsibilities include care management, care coordination, population health management, clinical affordability, and other related activities. The CMO works closely with a dynamic and experienced local leadership team as well as leveraging the extensive resources and capabilities of UnitedHealth Group.
The CMO of Health Services provides strategic leadership and is accountable for all clinical programs for all products and membership served by the health plan to ensure contractual compliance and achievement of clinical and utilization management goals. Because of the unique structure and alignment of clinical programs within United Healthcare, the role requires a high degree of coordination with external and internal business partners, including, but not limited to the UHC Clinical Services inpatient and Intake/Prior Authorizations, Appeals and Grievance, Quality, Optum case and disease management, NRS, Optum Behavioral Health, state Medicaid partners and other clinical specialty, external vendors, national programs, etc.
The CMO must work collaboratively with the local and national leadership to support achievement of state quality initiatives, HEDIS measures and to ensure compliance with relevant requirements of the state's annual Performance Review(S) conducted by the External Quality Review Organization (EQRO), state or other oversight body and meeting NCQA requirements. Additionally, the CMO will work collaboratively with the health plan leadership, business partners and finance to develop, implement/execute the Healthcare Affordability Plan, monitor outcomes of the planned initiatives and adjust the Plan as needed to meet targets.
The CMO must possess/develop a solid knowledge of all lines of business, product and cohorts within the health plan operations from a clinical standpoint. This includes all Medicaid cohorts including ABD, and LTSS as well as the Medicare Advantage programs.
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.
- Licensed unrestricted Medical license in the state of HI.
- Licensed physician; Board Certified in an ABMS or AOBMS specialty
- 5+ years clinical practice experience; strong knowledge of managed care industry and the Medicaid line of business
- 2+ years Quality management experience
- Experience in Value Based Contracting / Risk contracting
- Familiarity with current medical issues and practices
- Proven ability to develop relationships with network and community physicians and other providers
- Excellent project management skills
- Proficiency with Microsoft Office applications
- Excellent interpersonal communication skills
- Superior presentation skills for both clinical and non-clinical audiences
- Solid data analysis and interpretation skills; ability to focus on key metrics
- Strong team player and team building skills
- Strategic thinking with proven ability to communicate a vision and drive results
- Solid negotiation and conflict management skills
- Creative problem solving skills
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
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: CMO, Honolulu, HI