UnitedHealthcare National Medical Director
Value-Based Care Services for Government Programs
The National Medical Director of Value-Based Care Services for Government Programs participates in design, implementation, evaluation and evolution of value-based contracts in collaboration with UHN partners and is responsible for the development and implementation of population health programs designed to support Medicare & Retirement (M&R) and Community & State (C&S) value-based care provider contracts. In this role, you will drive improved affordability related to medical and pharmacy spend for lower TCOC, enhanced quality as evidenced by improved STAR performance, greater capture of state level quality based incentive and sanction dollars, and improved provider diagnosis, documentation and capture of member chronic conditions. To accomplish these goals, you will partner with the Government Programs team in the Population Health Division as well as close matrix partners from the M&R and C&S lines of business. This position will report to the CMO/SVP of Population Health and Value-Based Care and is a key member of the Population Health Leadership team.
- Collaborate closely with UHN Market Teams for government programs, including Market CMOs and health plan CEOs/Executive Directors to design, implement and evaluate innovative value-based contracts and evolving reimbursement models.
- Serve as clinical subject matter expert for needs assessment, design, implementation and evaluation of clinical programs to support M&R and C&S value-based contracting efforts and optimal VBC performance.
- Oversee UHC Population Health clinical support services and program delivery for M&R and C&S value-based care arrangements, including United Healthcare’s Medicaid Health Home teams and program, STARS and affordability related pharmacy work and Innovation program work to drive the Triple Aim. Create and implement new and innovative clinical programs for VBC provider groups to deliver improved quality and financial performance. Partner with training team for field-based team education to bring and support gov’t programs pop health programs to VBC provider groups.
- Develop enhanced clinical programming and oversee clinical support activities related to accurate diagnosis, documentation and coding (ADDC) associated with the CMS-HCC risk adjustment model to drive suspect condition closure rates across ACO and other VBC provider contracts.
- Provide clinical expertise to support VBC programs and processes to ensure that the highest quality, evidence-based guidelines and medical literature are utilized.
- Oversee comprehensive, standardized training program and ongoing education for market based UHC clinical teams (including clinical transformation consultants and Market CMOs) to ensure that new and existing staff are well-trained and up to date on key clinical programs, analytic tools and policies.
- Develop strong collaborative partnerships across a highly complex and matrixed organization including key partnerships with national M&R and C&S executive teams and market CMOs.
- M.D. or D.O. with an active, unrestricted medical license
- Active AMBS/AOBMS Board Certification
- Experience in a leadership position related to value-based care for government programs
- 5+ years of experience with and demonstrated functional knowledge of performance improvement initiatives
- 2+ years in managed care with strong knowledge of managed care industry and regulatory requirements and strong understanding of HEDIS, CAHPS and HOS
- 5+ years of hands on clinical experience
- Strong analytic skills and experience utilizing large data sets to measure and drive performance
- Effective strategic and critical thinking skills and proven ability to drive results, lead and communicate change effectively in a fast-paced environment and be adaptable within the changing environment
- Demonstrated ability in systems thinking and enterprise insight to solve complex business problems and strong analytical skills with ability to drive transformational, consumer-centric change and manage long-term programs
- Solid organizational, management, administrative and human relations skills
- Excellent, broad and clear written and oral communication skills for executive level and employee internal and external communications
- Proven success in organizational performance improvement
- Experience leading and mentoring teams
- Creative problem-solving skills
- Experience working in a highly matrixed and complex environment
- Strong history of quickly building relationships, gaining credibility and partnering with business leaders. Must excel at building teams and collaborating across multiple distinct business groups
- Excellent project management skills
- Ability and willingness to travel, approximately 25% nationally
- Advanced Degree, MPH, MBA
Colorado Residents Only: The salary/hourly range for Colorado residents is $293,200 to $324,800. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.