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CMO - UHC Community Plan of RI - Warwick, RI

UnitedHealth Group

Warwick, RI
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Job Details

731062 CMO UHC Community Plan of RI Warwick RI

CMO - UHC Community Plan of RI - Warwick, RI (731062)

Position Description

Medical Director careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work.


The Chief Medical Officer for UnitedHealthcare Community Plan of Rhode Island is a key leadership position focused on ensuring the plan delivers patient-centered, high quality and efficient care for its Medicaid membership. The position is responsible for overall clinical strategy and clinical model delivery, stewardship of external relationships including our State Partner and providers, improvement in quality and health outcomes metrics, affordability and cost savings initiatives, clinical leadership of Accountable Care Organizations and development of new clinical programs. The position will report to the Health Plan CEO and will be based in Warwick, RI.


Primary Responsibilities:

  • Leadership:
    • Provides clinical leadership to the Health Plan, accountable for clinical outcomes of the plan
    • Ensure the organization delivers safe, high quality and efficient care for our members, as measured by clinical outcomes and quality measures
    • Serve as primary expert on clinical delivery, representing the clinical perspective within leadership and the organization
    • Interacts, communicates, and collaborates with network and community physicians, hospital and ACO leaders, and other partners regarding clinical care and services for enrollees
    • Directs weekly team meetings and interdisciplinary rounds for communication, feedback, problem solving, staff training and development and sharing of program results
    • Leads health plan provider advisory councils and quality review committees
    • Engagement as needed with select member issues
  • Affordability, Clinical Operations and Quality
    • Leads the organization in identifying health care cost drivers and cost reduction opportunities, by leveraging data analysis and health care economics resources and tools
    • Reviews  utilization reports by product line, identifying changes in utilization or access patterns and monitor overall trends
    • Ongoing review of all clinical programs in order to assure they meet quality and affordability goals.
    • Designs and implements health programs that improve the health of our members and subsequently reduce clinical cost, partnering with internal program leads and with external provider partners
    • Leads internal teams in the tracking and management of clinical affordability programs
    • Supports the Quality program as clinical consultant; partners with Quality Director on accreditation activities
  • Program development and execution
    • Partners with local health services teams to ensure local clinical programs are executed appropriately, efficiently, effectively and within State compliance guidelines
    • Leads new clinical program development
    • Serves as MCO clinical champion for accountable care program development, working with health plan and transformation team leadership
    • Identify community and local partnerships for program innovation, development and improvement
  • State Partner Account Management
    • Serves as key clinical representative with State across all clinical functions
    • Leverages understanding of State contract and State program objectives to ensure health plan is pro-actively advancing the State relationship, and positioning UHC as an innovative, clinical leader
    • Partners with community organizations and the provider community, as well as with colleague MCOs, to advance the health plan and State agenda
    • Provides team leadership on key industry clinical trends and innovative programs, challenging the organization to advance its clinical model
  • Clinical Oversight
    • Along with Health Services Director, support and coordinate all clinical operations, including utilization management.
    • Key clinical liaison with Optum Behavioral Health, with focus on Medical Behavioral Integration
    • Assist in preparation for State Fair Hearings, and participate as needed.
    • Demonstrated leadership ability and outcomes in a complex or large organizational setting

Required Qualifications:

  • Current and non-restricted licensed physician; Board Certified in ABMS specialty
  • 5+ years’ post-licensure experience as a senior clinician and leader with responsibility for clinical standards, quality management, and clinical supervision in a health plan organization
  • Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, quality management, and peer review
  • Strong operational focus with demonstrated data analysis / interpretation acumen, project management, change management, and execution skills
  • Self-motivated and able to work with little direct supervision and drive results with disciplined follow-though
  • Strong strategic thinking and business acumen with the ability to align clinical related strategies and recommendations with business objectives
  • Adaptable and flexible style of collaborating with key stakeholders in setting direction
  • Proven ability to quickly gain credibility, influence and partner with employees, business leaders and the clinical community
  • High integrity with a reputation of a trusted confidential advisor and partner
  • Visibility and involvement in medical community
  • Ability to develop relationships with network and community physicians and other providers
  • Demonstrated leadership ability and outcomes in a complex or large organizational setting
  • Excel lent presentation skills for both clinical and nonclinical audiences

Preferred Qualifications:

  • 5+ years’ experience in Medicaid / Medicare government programs

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, UHC, Community Plan of Rhode Island, Warwick, RI, Rhode Island

Job Details

  • Contest Number731062
  • Job TitleCMO - UHC Community Plan of RI - Warwick, RI
  • Job FamilyMedical and Clinical Operations
  • Business SegmentCommunity and State

Job Location Information

  • Warwick, RI
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job Level
  • ShiftDay Job
  • TravelYes, 25 % of the Time
  • Telecommuter PositionNo
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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