Chief Medical Officer - UHC Community Plan of Tennessee - Nashville, TN
Company: Optum
Location: Nashville
Posted on: May 16, 2022
Job Description:
Medical Director opening in Nashville, Tennessee. This and other
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Are you ready to seize this opportunity to do your greatest work as
a physician by leading teams to help Tennessee's most vulnerable
population lead healthier and happier lives? UnitedHealthcare is
creating opportunities in every corner of the healthcare
marketplace to improve lives while building careers.
Innovation isn't about another gadget; it's about transforming the
health care industry through integrated clinical models and
value-based provider programs that combine to deliver the quadruple
aim statewide in Tennessee. That means continuous career growth
opportunities for you. While we support you with the latest tools,
advanced training, and the combined strength of high caliber
co-workers, you can continue following the path of your life's best
work.SM of Chief Medical Officer (CMO) for UnitedHealthcare
Community plan of Tennessee.
This Community and State (C&S) Health Plan serves over half a
million Tennesseans receiving Medicaid benefits. The CMO role is
accountable for ensuring these Tennesseans achieve high quality
clinical outcomes as evidenced by exceptional quality performance
ratings, as well as high member and provider satisfaction scores.
Furthermore, healthcare transformation is a priority focus of the
CMO by continuously advancing a clinical model that engages
underserved individuals in a population health model that is
supported by integrated community care teams and over 3,000
providers in a value-based payment model.
This position reports to the Health Plan's Chief Executive Officer
(CEO) and has dotted line relationships to the C&S CMO as well
as to the Enterprise Clinical Services (ECS) Regional CMO. The
CMO's primary responsibilities are directed towards local C&S
plan activities as defined by the Health Plan's CEO. The CMO
collaborates with ECS staff including the regional CMO, and other
market and regional shared service partners to implement the State
of Tennessee's TennCare programs for its managed Medicaid Program.
Activities support national, regional and local business goals
tailored for the Tennessee Medicaid market.
Primary Responsibilities:
- Quality and Affordability - The Health Plan CMO has primary
responsibility and accountability for quality medical outcomes and
performance while championing healthcare affordability projects
that ensure members receive the best possible care. This requires a
close working relationship with the Bureau of TennCare's clinical
leadership team, ECS operations teams and with UnitedHealthcare's
national healthcare economics team. The CMO serves as the clinical
leader for healthcare affordability initiatives in the local
market. Additionally, the CMO is a primary stakeholder in clinical
model operations including Person-Centered Care Models (PCCM),
Tennessee Delivery System Transformation and Value Based Program
(VBP) relationships. This includes the design, collaboration, and
implementation of new and or improved Models of Care programs such
as those defined by the State contract, by Centers for Medicare and
Medicaid Services (CMS). The CMO has oversight responsibility of
the local market peer review process as defined by TennCare, as
well as participating in or leading the regional UHC Peer Review
committee.
- Clinical Excellence - The Tennessee Health Plan CMO supports
the HEDIS and STARs data collection process, CAHPS improvement
strategy, and drives Health Plan accreditation activities. The CMO
also ensures strong HEDIS, Stars and TennCare defined performance
measures results to support all advanced payment models. The CMO
acts as an improvement catalyst for all quality-related efforts
including Center for Medicare and Medicaid Services Star
initiatives. Communicates to providers on new focus and
measure/process changes. Supports all Clinical Quality initiatives
and peer review processes including Quality of Care and Quality of
Service issues; participates or leads Physician Advisory Committees
(PAC); Quality Management Committee (QMC) and other associated
quality focused committees.
- Relationship Equity and State Compliance - The Plan CMO
maintains a strong working knowledge of all government mandates and
provisions for the Tennessee Medicaid market, as well as working
across the enterprise to implement and maintain compliant clinical
programs and procedures. The CMO must be effectively engaged with
external constituents such as consumers/members, physicians,
medical and specialty societies, hospitals and hospital
associations, federal/state regulators, and market-based
collaborative. The CMO will work collaboratively in these
activities with ongoing ECS initiatives under the aegis of ECS
Regional CMO. The Plan CMO will be the outward face to State
regulators based upon Contract requirements and direction of Plan
President. The CMO provides clinical thought leadership with
external entities, to include TennCare.
- Innovation - The Plan CMO leads the clinical interface with
care providers and UHC network management colleagues in efforts to
transform the health system. Primary local responsibility is to
drive PCCM/Accountable Care Community (Tennessee's Patient Centered
Medical Home) growth through identification of appropriate
practices; initial contact and target setting, and Implementation,
as well as ongoing leadership during regular Joint Operating
Committees (JOCs.) CMO is accountable for oversight of the entire
clinical model (end to end) within the market. Knowledge of VBP
contracting variants for Medicaid is an essential secondary
responsibility that includes 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 engagement. Knowledge of and dedication
to developing and improving an integrated service clinical model
(medical, behavioral, and social risk) is required. The CMO must
also create a culture of diversity and inclusion, with supporting
programs targeted to reduce health disparity.
- Growth – The CMO delivers the clinical value proposition
focused on quality, affordability, and service, in support of
growth activities of the C&S Health Plan. The CMO reviews and
edits communication materials as required and represents the voice
of the market-based customer in program design. CMO contributes to
any RFP/re-procurement activity in the state. The Plan CMO actively
promotes positive relations with State/local regulatory authorities
and Medical Societies and records.
- Grievance and Appeals - The Plan CMO maintains an active
liaison with ECS Grievance & Appeals and is responsible for leading
a clinical team overseeing and or representing the Local C&S
plan at state-level fair hearings at the state's request. This work
is integrated with the health plan operations team by providing
leadership in evaluating both requests from the State for
Independent Reviews and formal Provider Complaints.
Demonstrable Skills and Experience:
- Ability to build a team that values organizational and health
plan success over personal success; provide ongoing coaching and
feedback to ensure peak performance; identify and invest in high
potentials; actively manage underperformance
- Ability to focus staff on the company's mission; inspire
superior performance; ensure understanding of strategic context;
set clear performance goals; focus energy on serving the customer;
provide ongoing communication to the team; discontinue non-critical
efforts
- Ability to drive disciplined fact-based decisions
- Ability to execute with discipline and urgency; drive
exceptional performance; deliver value to the customer; closely
monitor execution; drive operational excellence; get directly
involved when needed; actively manage financial performance;
balance speed with analysis; ensure accountability for results. CMO
is a leadership position within the health plan, a part of the "C"
Suite, a skilled General Manager with a clinical expertise
- Ability to drive change and innovation though continually
seeking and implementing innovative solutions; create a culture
that thrives on continuous change; inspire people to stretch beyond
their comfort zone; take well-reasoned risk; challenge "the way it
has always been done"; change direction as required
- Ability to model and demand integrity and compliance
- Proven ability to execute and drive improvements against stated
goals
- Ability to develop relationships with Tennessee State
government clinical leadership, network and community physicians
and other providers
- Ability to be visible and be involved in medical
community
- Ability to successfully function in a matrix organization
exhibiting the culture of United Health Group
CMO Leadership Expectations:
- Deliver value to members by optimizing the member experience
and maximizing member growth and retention
- Lead and influence Health Plan employees by fostering teamwork
and collaboration, driving employee engagement, and leveraging
diversity and inclusion
- Develop and mentor others while also building awareness to your
own strengths and development needs
- Influence and negotiate effectively to arrive at win-win
solutions
- Communicate and present effectively, listen actively and
attentively to others, and convey genuine interest
- Lead change and innovation by demonstrating emotional
resilience, managing change by proactively communicating the case
for change and promoting a culture that thrives on change
- Play an active role in implementing innovative solutions by
challenging the status quo and encouraging others to do so
- Drive sound and disciplined decisions that drive action while
effectively using financial knowledge and data to manage the
business
- Drive high-quality execution and operational excellence by
communicating clear directions and expectations
- Manage execution by delegating work to maximize productivity,
exceed goals and improve performance
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.
Required Qualifications:
- Active and unrestricted Tennessee medical license as a Doctor
of Medicine (MD) or Doctor of Osteopathy (DO)
- Board Certified in one or more of Internal Medicine, Family
Medicine, Pediatrics, OB/GYN, or Psychiatry
- Current DEA licensure and prescriptive authority in the state
where applicable
- 5+ years of clinical practice experience
- 2+ years of Quality Management experience
- Solid knowledge of managed care industry and the Medicaid line
of business, including Utilization Management
- Reside in the greater Nashville, Tennessee area
- Full COVID-19 vaccination is an essential job function of this
role. Candidates located in states that mandate COVID-19 booster
doses must also comply with those state requirements. UnitedHealth
Group will adhere to all federal, state and local regulations as
well as all client requirements and will obtain necessary proof of
vaccination, and boosters when applicable, prior to employment to
ensure compliance. Candidates must be able to perform all essential
job functions with or without reasonable accommodation.
Preferred Qualifications:
- Master's degrees in public health, business administration and
or HealthCare Administration
- Familiarity with current medical issues and practices
- Superior presentation skills for both clinical and non-clinical
audiences
- Proven ability to develop relationships with network and
community physicians and other providers
- Solid data analysis and interpretation skills; ability to focus
on key metrics
- Solid team player and team building skills
- Strategic thinking with proven ability to communicate a vision
and drive results
- Solid negotiation and conflict management skills
- Proficiency with Microsoft Office applications
- Creative problem-solving skills
- Solid leadership skills, as demonstrated by continuously
improved results, team building, and effectiveness in a highly
matrixed organization
- Excellent interpersonal communication skills
- Excellent project management skills
To protect the health and safety of our workforce, patients and
communities we serve, UnitedHealth Group and its affiliate
companies require all employees to disclose COVID-19 vaccination
status prior to beginning employment. In addition, some roles and
locations require full COVID-19 vaccination, including boosters, as
an essential job function. UnitedHealth Group adheres to all
federal, state and local COVID-19 vaccination regulations as well
as all client COVID-19 vaccination requirements and will obtain the
necessary information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employment
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.
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Keywords: Optum, Nashville , Chief Medical Officer - UHC Community Plan of Tennessee - Nashville, TN, Executive , Nashville, Tennessee
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