12 days old

Community & State Health Plan Chief Population Health Medical Officer - Minnesota - 936530

Minnetonka, MN 55345
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  • Job Code
    936530

The C&S Plan Chief Population Health and Medical Officer has accountability for ensuring that local health plan, Enterprise Clinical Services (ECS) and UnitedHealthcare (UHC) initiatives focusing on clinical excellence, population health, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system transformation including provider network and partnership, compliance with regulatory mandates, growth and other focused improvements are implemented and successfully managed to achieve goals. This position reports to the Minnesota C&S health plan Chief Executive Officer and has a dotted line relationship to the C&S Chief Medical Officer. The Minnesota C&S Plan CPHMOs primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO and also collaborates with Enterprise Clinical Services (ECS) staff including local and regional Chief Medical Officers, and other market and regional matrix partners to implement programs to support and meet C&S health plan, C&S line of business, ECS and UHC goals. As our Medicaid-dedicated clinical leader they will focus on improving health equity and developing strong community partnerships.

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Major Responsibilities

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  • Population Health: The Plan CPHMO has accountability to identify opportunities to address and improve disparities and key health outcomes in the communities that we serve, and responsible for translating that into actionable activities in partnership with our community and enterprise partners. Additionally, the CPHMO will focus on driving improvement in health outcomes through initiatives that address systemic racism in close collaboration with our Director of Health Equity. The CPHMO will utilize various health analytic tools to assess success and rapidly adjust the direction of the health plans population health initiatives to ensure that we meet our goals to deliver on the triple aim and to drive a strategy to address racism and health equity.
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  • Community Partnerships: The Plan CPHMO will engage and partner with local stakeholders and community-based organizations to identify priorities of the communities we serve regarding health and social needs and address these needs through collaborations and targeted investments. The CPHMO will develop existing and new relationships with a multitude of partners in the health care delivery system-including providers and vendors- to develop and implement programs focused on driving to the triple aim.
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  • Quality and Affordability The Plan CPHMO has primary responsibility and accountability for Total Medical PMPM performance and targets for the local C&S plan. This will require a close working relationship with ECS clinical operations teams, Optum Behavioral Solutions, Optum Transplant, Optum Neonatal Resource Solutions, and other internal clinical vendors, as well as with the C&S and ECS national affordability teams. Activities will include responsibility to oversee collaboration with the BH ASO vendor and new clinical model operations as well as new Models of Care such as those defined by CMS or the Minnesota Department of Health. Additional responsibilities include participating in hospital Joint Operations Committee meetings with prioritized providers in coordination with UnitedHealth Network (UHN) and ECS, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, completing peer to peer communications for quality of care as required, and implementing local and national Health Care Affordability Initiatives in order to achieve inpatient and outpatient utilization and affordability goals.
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  • Clinical Excellence The C&S plan CPHMO provides oversight to the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, and drives Health Plan accreditation activities as well as quality rating improvement initiatives and other clinical interventions for the local C&S plan. The CPHMO is responsible for achievement of goals for contractually required clinical Quality Performance Indicators and state regulator-driven pay-for-quality initiatives. The CPHMO oversees market peer review processes including Quality of Care and Quality of Service issues, and leads the Physician Advisory Committee (PAC), Quality Management Committee (QMC) and other associated committees.
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  • Relationship Equity and State Compliance - The Plan CPHMO maintains a strong working knowledge of all government mandates and provisions for the local C&S market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. S/he also is committed to being effectively engaged with our external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives. The C&S plan CPHMO will work collaboratively in these activities with the ECS local and regional CPHMOs. The Plan CPHMO will be the outward face to State regulators based upon Contract, and direction of Plan CEO and C&S CPHMO and should provide clinical thought leadership with external entities and the state.
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  • Health Equity The Plan CPHMO has a leadership role in helping develop a strategy to identify clinical areas where there are disparities in health outcomes across groups, and approach to closing gaps in health outcomes. The CPHMO also supports the team in maintaining NCQA Multi-Cultural Distinction designation.
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  • InnovationThe Plan CPHMO leads the clinical interface with care providers and UHN (network management) colleagues in efforts to transform the health system. Primary local responsibility includes driving quality improvement and provider incentive models through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership during monthly JOCs. CPHMO is accountable for oversight of the entire clinical model (end to end) within the market. Knowledge of alternative payment model variants for C&S will be essential. Secondary responsibility will include but not limited to, UHCs 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.
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  • Growth The CPHMO delivers the clinical value proposition focused on quality, affordability, and service, in support of growth activities of the C&S Health Plan. The plan CPHMO reviews and edits communications materials as required and represents the voice of the market-based customer in program design. CPHMO contributes to any RFA activity and clinical innovations. The Plan CPHMO actively promotes positive relations with State/local regulatory authorities and Medical Societies.
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  • Focused Improvement The Plan CPHMO is responsible for identifying opportunities through participation in regional and local Market reviews, and healthcare economics analyses. S/he actively participates in various Joint Operating Committees. S/he also provides oversight of the performance of Enterprise Clinical Services including the Inpatient Care Management team and Clinical Coverage Review team (prior authorization), Appeals and Grievances, Optum Behavioral Solutions, Optum Physical Health, OptumRx and other OptumHealth or shared services teams.
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  • Grievances and Appeals- the Plan CPHMO maintains an active liaison with UnitedHealth A&G and is responsible for representing the Local C&S plan at State-level Fair Hearings.
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Demonstrable Skills and Experiences:

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  • Proven ability to execute and drive improvements against stated goals. Drive disciplined fact-based decisions through effective use of financial knowledge and data.
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  • Deliver value to members by optimizing the member experience and maximizing member growth and retention.
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  • Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusion.
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  • Develop and mentor others while also building awareness to your own strengths and development needs; identify and invest in high-potential colleagues; actively manage underperformance.
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  • 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.
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  • Influence and negotiate effectively to arrive at win-win solutions.
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  • Communicate expectations and present effectively, listen actively and attentively to others, and convey genuine interest.
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  • Execute with discipline and urgency: Drive exceptional performance; deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed and delegate work to maximize productivity; actively manage financial performance; balance speed with analysis; ensure accountability for results. CPHMO is a leadership position within the health plan, a part of the C Suite, a skilled General Manager with a clinical expertise.
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  • 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
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  • Model and demand integrity and compliance
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  • Has a positive, flexible, and informed account management approach when working with members of the Minnesota Department of Health
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  • Visibility and involvement in medical community
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Qualifications:

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  • Minnesota active/unrestricted licensed Physician
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  • Board Certified in an ABMS or AOBMS specialty
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  • 5+ years clinical practice experience; strong knowledge of managed care industry and the Medicaid line of business.
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  • 2 3 years Quality management experience
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  • Familiarity with current medical issues and practices
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  • Strong leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organization
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  • Excellent interpersonal communication skills
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  • Superior presentation skills for both clinical and non-clinical audiences
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  • Proven ability to develop relationships with network and community physicians and other providers
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  • Excellent project management skills
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  • Solid data analysis and interpretation skills; ability to focus on key metrics
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  • Strong team player and team building skills
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  • Strategic thinking with proven ability to communicate a vision and drive results
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  • Solid negotiation and conflict management skills
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  • Creative problem-solving skills.
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  • Proficiency with Microsoft Office applications
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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

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"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.

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"UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Posted: 2021-06-09 Expires: 2021-07-09

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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Community & State Health Plan Chief Population Health Medical Officer - Minnesota - 936530

UnitedHealth Group
Minnetonka, MN 55345

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