Appeals Medical Director - PM&R Required

At UnitedHealthcare, we’re 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. 
 UnitedHealthcare’s Market CMOs serve as the local senior clinical executive for their line of business, with accountability for:
<ul>
<li style="font-family: Tahoma;">Achieving defined clinical outcomes, affordability goals and growth targets, in partnership with their health plan leadership team</li>
<li style="font-family: Tahoma;">Provide clinical insight into market data and implementing tailored interventions to address clinical trends and opportunities for their state or region</li>
<li style="font-family: Tahoma;">Serving as a central health plan leader accountable to facilitate coordination with UnitedHealthcare and Optum national clinical and operational functions</li>
<li style="font-family: Tahoma;">Actively engage and help drive performance with market-level quality, network, and compliance teams</li>
<li style="font-family: Tahoma;">Building and deepening relationships with area hospitals, physicians, and other health care providers</li>
<li style="font-family: Tahoma;">Advocate for UnitedHealthcare’s clinical value story, evidence-based medical policies, and member health with government/state regulatory entities, professional and medical society chapters, </li>
<li style="font-family: Tahoma;">employers, and as part of external communications and media relations</li>
<li style="font-family: Tahoma;">Provides subject/specialty based clinical expertise and leadership to UCS and the enterprise, as needed</li>
</ul>
 If you are located in IL, you will have the flexibility to work remotely* as you take on some tough challenges. 
 Primary Responsibilities:
<ul>
<li class="MsoNormal" style="line-height: normal;">Clinical Affordability - CMOs are responsible for achieving their assigned incremental savings goal and support the national savings target for the year. Driving savings is a two-pronged, data-driven approach of local response and national implementation, where CMOs lead targeted clinical inventions to address local market trends and needs, and support on-the-ground alignment with national utilization management programs. Inform and drive local and national affordability initiatives: CMOs are expected to apply healthcare economics insights and escalate local issues and trends</li>
<li class="MsoNormal" style="line-height: normal;">Network / Provider Engagement - The CMO serves as the local clinical point of contact for physicians, systems, and other care providers and with UnitedHealth Networks colleagues. Key activities include UHC’s Accountable Care Platform, value-based contracting, clinical practice transformation, patient-centered medical homes, and transparency initiatives such as UnitedHealth Premium® Designation and/or High Performing Physicians. The CMO meets regularly with hospitals and physician groups and shares data on quality and efficiency improvement opportunities and developing action plans for sub-optimal results</li>
<li class="MsoNormal" style="line-height: normal;">Market Relationships - The CMO is the clinical face of UnitedHealthcare to elected officials, policy makers, plan sponsors, medical and professional societies, news media, and community-based organizations. The CMO is engaged in regular, proactive dialogue with our external constituents to advance evidence-based medicine and support best practices in health care delivery</li>
<li class="MsoNormal" style="line-height: normal;">Quality & Compliance - The CMO maintains a solid working knowledge of all government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures.  The CMO also supports quality improvement efforts as measured by CMS Star Ratings, NCQA Star Ratings, HEDIS, CAHPS, HOS and other national and company metrics. The CMO partners with UHC Compliance to ensure clinical management regulatory obligations regarding clinical management are met. Market CMOs also chair required Quality Oversight Committees at a market/regional level</li>
</ul>
 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:
<ul>
<li style="font-family: Tahoma;">Active and unrestricted Illinois State Medical License</li>
<li style="font-family: Tahoma;">Board Certified in an ABMS or AOA specialty </li>
<li style="font-family: Tahoma;">5+ years clinical practice experience</li>
<li style="font-family: Tahoma;">Ability/experience in developing collaborative relationships with health system clinical leadership  </li>
<li style="font-family: Tahoma;">Solid knowledge of managed care industry</li>
<li style="font-family: Tahoma;">Solid knowledge of health care utilization data and analytics</li>
<li style="font-family: Tahoma;">Familiarity with current medical issues and practices</li>
<li style="font-family: Tahoma;">Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)</li>
<li style="font-family: Tahoma;">Proven excellent interpersonal communication skills and ability to influence in executive settings</li>
<li style="font-family: Tahoma;">Proven superior presentation skills for both clinical and non-clinical audiences</li>
<li style="font-family: Tahoma;">Proven ability to identify an improvement opportunity through data, implement a solution and achieve measurable impact. Solid data analysis and interpretation skills; KPI metrics driven.</li>
<li style="font-family: Tahoma;">Proven ability to develop relationships with network and community physicians and other providers</li>
<li style="font-family: Tahoma;">Capable to quickly become facile with UHC/UHG specific data systems</li>
<li style="font-family: Tahoma;">Ability to travel within the assigned market - 30%25 travel required</li>
<li style="font-family: Tahoma;">Reside in, or be willing to relocate to Illinois State; within proximity to UHC corporate offices</li>
</ul>
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Preferred Qualifications:
<ul>
<li style="font-family: Tahoma;">Advanced Business, Public Health, Medical Management degree</li>
<li style="font-family: Tahoma;">Health plan experience in similar leadership capacity</li>
<li style="font-family: Tahoma;">Proven solid team player and team building skills</li>
<li style="font-family: Tahoma;">Proven solid negotiation and conflict management skills  </li>
<li style="font-family: Tahoma;">Proven creative problem-solving skills</li>
<li style="font-family: Tahoma;">Proven strategic thinking with proven ability to communicate a vision and drive results</li>
</ul>
 *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
 Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.    

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
 At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves 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 - an enterprise priority reflected in our mission.


UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
 UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Appeals Medical Director - PM&R Required - Remote

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