Job Description

At UnitedHealthcare, we\xe2\x80\x99re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Community Plan of Hawaii Chief Medical Officer (CMO) will use their proven track record to become the end-to-end owner of the clinical programs for Hawaii Community & State. The position has accountability for all Medicaid clinical product offerings, clinical market strategies, clinical support for sales and growth opportunities, collaboration and engagement with our Shared Services clinical team, clinical data analysis to improve clinical and cost outcomes, new clinical program implementations, monitoring and valuing clinical outcomes and operational performance, driving affordability pipeline and performance, overseeing development and implementation of initiatives to meet quality standards, ensuring compliance with state Medicaid compliance standards-where applicable, and appropriate capital stewardship.

If you are located in Hawaii, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Develop solid collaborative partnerships across a highly complex and matrixed organization including key partnerships with the local Market leadership team, functional VPs, Market CMOs, health plan CEOs and Executive Directors across all lines of business (Commercial, Medicare, Medicaid)

• Oversight of clinical processes and policy decisions with a focus on implementing plans of care that mee t accepted guidelines and protocols to ensure that optimal and appropriate medical & clinical services are provided

• Drive improved affordability related to medical and pharmacy spend for lower TCOC, greater capture of state level quality-based incentive dollars, and improved provider diagnosis, documentation and capture of member chronic conditions

• Ensure services are delivered to members at the highest quality standards. Oversee and ensure development and implementation of initiatives to meet or exceed HEDIS quality standards, and accreditation standards through working with and holding Quality Shared Services accountable

• Continuously improve HEDIS, and CAHPS scores for members and providers

• Provide guidance and direction to physicians and nurses regarding all aspects of medical care and multi- level transitions of care including the referral process as well as any quality-of-care concern and related plans of correction

• Review inpatient cases where applicable for successful bed-day management that meets established company goals

• Analyze utilization data to identify trends and opportunities for process improvement related to medical treatment (inpatient and outpatient)

• Serve as clinical subject matter expert for needs assessment, design, implementation, and evaluation of clinical programs to support continued growth and affordability of the Health Plan

• Participate in senior medical management strategy development and implementation to ensure that appropriate care and services provided to members meet best practice standards as well as regulatory compliance requirements and Internal Quality Assurance Program

• Educate physicians and nurses in effective management of Health Plan benefits and medical services that meet the needs of the members and utilizes resources appropriately

• Knowledge and proficiency in applying Hawaii Med-QUEST division rules and regulations

• Development, implementation, and oversight of the population health strategy to include health equity and cultural competency

• Oversees provider recruitment and credentialing

• Serves as co-chairman of the Health Plan\xe2\x80\x99s Utilization Management and Quality Assurance Plan committee

• Oversees the development and revision of the Health Plan\xe2\x80\x99s clinical care standards and practice guidelines and protocols

• Ensures coordination of Out-of-Network services

You\xe2\x80\x99ll 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:

• Active/unrestricted Hawaii M.D/D.O. license

• Active Board Certified in an ABMS/AOBMS Specialty

• 5+ years of direct patient facing clinical work

• Proven broad and comprehensive knowledge of medical management principles and insurance products for multiple and varied lines of business in a managed care environment

• Proven solid knowledge of Population Health and it\xe2\x80\x99s community health care environment, the provider network and managed care contracting processes

• Demonstrated good understanding of managed care systems, quality improvement and risk management

Preferred Qualifications:

• 8+ years of progressively responsible management experience preferably in a managed care setting

Competencies and Best Practice for High Performers:

• Demonstrated excellent medical management and leadership skills required

• Demonstrated excellent communication skills required

• Good skills in making presentations and teaching preferred

• Solid organizational and prioritization skills required

• Ability to contribute to the organization\xe2\x80\x99s efforts to eliminate racial and ethnic disparities in organizational performance and support cultural awareness

*All employees working remotely will be required to adhere to UnitedHealth Group\xe2\x80\x99s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone\xe2\x80\x93of every race, gender, sexuality, age, location and income\xe2\x80\x93deserves 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 \xe2\x80\x94 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.

UnitedHealth Group