UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
National Medical Director/CMO - TRICARE-316678
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description UnitedHealth Military & Veterans Services is part of the family of companies that make UnitedHealth Group one of the leaders across the US health care system.
We serve those who serve our nation, providing quality health care services to millions of military beneficiaries across the South.
Our commitment to helping people live healthier lives, and to continue the honor, satisfaction, and quality of the TRICARE military health benefit program is greater than ever. Our efforts complement the Military Health System to demonstrate the best blend of public and private health care solutions.
It's not just business as usual. It is one of our proudest endeavors.
If you're ready to help make health care work better for those who serve our nation. If you are smart, creative, and committed. If you want to make a difference. Consider being part of the elite team at UnitedHealth Military & Veterans Services.
UnitedHealth Military & Veterans Services (UMVS) was formed by UnitedHealth Group as a dedicated business unit focused on the needs of the Department(s) of Defense and Veterans Affairs and devoted to providing high-quality, cost-effective health care to the nation's military, veterans and their families.
In July, 2009, the Department of Defense awarded UMVS the TRICARE Managed Care Support Contract for the South Region. For this contract, UMVS will provide health care services to approximately three million TRICARE beneficiaries in the South Region, including military service members, retirees and their families.
UMVS is part of the family of companies that make UnitedHealth Group a health care leader across most major segments of the U.S. health care system. Working with health care professionals, UnitedHealth Group enhances the performance of the health care system and improves the overall health and well-being of the people we serve and their communities. We provide access to high-quality health care so people get the care they need at an affordable price and empower people with the information, guidance and tools they need to make personal health choices and decisions.
The UMVS Chief Medical Officer is responsible for driving the clinical strategy for UnitedHealth Military & Veterans Services by leveraging UnitedHealth Group's capabilities to create innovative and comprehensive programs to serve the unique needs of a mobile and diversified Military and Veterans Health System(s). The Executive will have specific accountability for achieving clinical performance objectives such as targeted health quality outcomes and medical trend management for the beneficiaries served by UMVS.
This individual partners closely with UMVS leaders, UnitedHealth Group corporate medical policy leadership, Public Sector Market Group leaders (all UnitedHealth Group government businesses including Medicare and Medicaid) and sister UnitedHealth Group companies (e.g.; OptumHealth) to ensure that clinical programs, systems and resources meet the unique needs of our customers and comply with federal and TRICARE regulations. This role is a direct report to the CEO of UnitedHealth Military & Veterans Services.
Key Responsibilities
- Serve as the principal medical professional head and advisor for UMVS medical staff. Represent UMVS through clinical leadership and consultative guidance for all customer engagements and partnerships to improve population-based health management, safety and quality management programs for military and veteran health services.
- Develop and apply UnitedHealth Group evidence-based clinical strategies, medical policies, clinical guidelines, clinical technologies, technology assessments and reimbursement strategies to establish programs that advance military managed clinical services. Leverage UHG capabilities to advance coordination between direct military/veteran health care systems and civilian purchased care services.
- Provide overall clinical leadership for the medical management and quality management/improvement programs for the TRICARE South Region Managed Care Support Contract. Collaborate with the UMVS Medical Services team to establish an advanced military medical management program (medical, surgical, behavioral, military special needs) compliant with TRICARE requirements and federal regulations. Ensure clinical systems, models and processes are appropriately deployed to execute on UMVS' contracted TRICARE health quality and clinical performance targets. Provide medical director oversight in areas such as authorization, utilization review, retrospective claims review, appeals and grievances, peer review cases and other clinical operations functions.
- Partner with UMVS provider network and health care reporting and analysis teams to ensure appropriate medical trend metrics are in place. Conduct and commission detailed analyses to evaluate clinical utilization trends and develop corrective action plans as needed. Ensure that provider network strategies and contracting approaches are consistent and aligned with clinical strategies and that clinical interventions are achieving desired outcomes and returns.
- Work closely with UMVS regional field leaders to assess and prioritize market specific health care cost and quality initiatives and align national clinical resources with local market needs. Identify opportunities to collaborate with health care partners in the military communities served to supplement core clinical services delivery.
- Participate in the selection of community partners, ensure they are appropriately trained on UMVS services and clinical models, systems and processes. Monitor service delivery and hold accountable for achievement of medical trend management and health quality outcomes.
- Collaborate with UMVS compliance staff to perform annual assessments of all medical management activities to ensure compliance with TRICARE and federal requirements and regulations. Participate in all government audits of medical management activities. Continually evaluate the need for process changes due to new TRICARE and federal regulations. Provide leadership, subject matter expertise, clinical oversight and consultation to Quality Management and Improvement activities.
This is an opportunity to share in something special; a chance for all of us to serve, to excel, and to know that we've made a difference for those families who have made our nation stronger. Qualifications
Qualifications:
ï‚· Board certified and licensed physician. REQUIRED
ï‚· 15+ years related clinical experience, with a combination of service delivery in a clinical setting and managed health system environment. 5+ years experience in managed care environment focusing on medical management initiatives within a military and/or commercial environment. REQUIRED
ï‚· Experience managing healthcare outcomes/costs across multiple locations. REQUIRED Previous national responsibility/scope strongly preferred.
ï‚· In depth understanding of the end-to-end operations of a managed care business, with practical knowledge of the interdependencies between key stakeholders and processes (e.g. beneficiaries, provider, clinical, information systems, operations). Track record of continuous improvement in operational quality (e.g. process improvement methodologies), including confirmed success in leveraging clinical systems and technology solutions to support evidence based decision making.
ï‚· Knowledge of Military Health System and TRICARE regulations, programs, and populations. Knowledge and/or previous responsibility for coordination activities between the direct military health system and purchased care systems. REQUIRED
ï‚· Demonstrated expertise in planning, monitoring and influencing financial metrics and outcomes (budgets, medical expense trends, health care economics, etc.). Proven track record of achieving clinical and economic medical management outcomes.
ï‚· Demonstrated commitment to improving access and quality of care to our nation's military, veterans, retirees and their families.
ï‚· Ability to travel (approximately 30%) REQUIRED
ï‚· Strategic Vision combined with Operational Execution: Thinks strategically and implements tactically to consistently deliver results.
ï‚· Business Planning and Implementation: Experience applying innovative and creative approaches to improve healthcare delivery; ability to set priorities and manage expectations; demonstrated success in designing, implementing and operating programs that measure and positively modify behavior.
ï‚· Networking, Collaboration and Consensus Building: Ability to influence chief executive officers, medical directors and nurses in a matrix environment; ability to defend initiatives when challenged and accept constructive criticism in a collaborative environment; knowledgeable of how decisions impact all aspects of the business; approaches his/her work as an interconnected system.
ï‚· Relationship Building: Ability to maintain relationships in politically sensitive areas;
ï‚· Integrity and Compliance: Honest and highly ethical team player; adheres to UHG Code of Conduct; demonstrated commitment to serving military and veterans.
ï‚· Understanding Others: Appreciation of cultural diversity and the needs of serving a diverse patient population; sensitive to the needs of members as well as the company's overall goals.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
