National Medical Director Clinical Program Governance, Evaluation, and Innovation - Remote

UHC Nation Medical Director Clinical Program Governance, Evaluation and Innovation

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The UHC Nation Medical Director Clinical Program Governance, Evaluation and Innovation is part of the UCS Clinical Evidence Group. This physician is responsible for supporting and driving key clinical program governance, disciplined evaluation, and leading a team testing innovative solutions and care models in close collaboration with the National CMO of the UCS Clinical Evidence Group. The portfolio of efforts for which the incumbent will provide guide and lead, in collaboration with the National CMO of CEG includes:

1. Clinical Program Governance process and team which is charged with ensuring deployed clinical programs represent our best opportunity to improve health, optimize member and provider experience while reducing unwarranted healthcare spending. The core process (Clinical Program Review (CPR)) evaluates clinical programs annually for program performance and design as well alignment our member and health plan needs. The process aims to optimize our clinical program investments, ensuring that the portfolio reflects our best opportunity to improve health, enhance experience, and reduce unwarranted spending. The CPR governance effort also includes: support of early program development through the clinical program Ideation Front Door (IFD) process and, clinical review of vendor candidates for the UHC & Optum Hub and Store and review of AI deployments in the clinical space.
2. Clinical Program Evaluation -this team designs trials, plans statistical analyses, and evaluates innovative program and care model deployments. Evaluation of pragmatic trials, medical policy impact analyses, and evaluation of provider-focused incentives to adopt innovative care models.
3. Clinical Program Innovation- Lead identification and vetting of top priority clinical solutions and care models to deploy in robust pilots. Monitor deployed solutions and lead internal customer relations as well as vendor and provider relationships.

Collectively the Evaluation and Innovation efforts generate real world evidence to inform plan and benefits evolution while the governance process ensures continuous monitoring and refinement of imagined or deployed programs.

The Director will report to the National CMO of the Clinical Evidence Group and manage the CPR team of 5-7 people.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Governance:
  • Bring a seasoned clinical lens to the review of clinical programs to ensure the clinical model is optimized for impact and experience
  • Review program performance measurement in advance of committee meetings to ensure reports are clear, complete, up to date and transparent These include HCE impact assessments on financial impact
  • Work with CPR Committee Chair, Director, team and stakeholders to maintain a disciplined processes for operation, documentation, and communication
  • Manage the CPR team of 5-7 people under the Director, charged with operating the Ideation Front Door process, the Clinical Discovery Forum and the Clinical Program Review in close collaboration with program owners, health plan leaders and Healthcare economics teams
  • Ensure that the team follows up with clinical program owners and operations teams regularly to ensure CPR recommendations are implemented (or understand why not)
• Clinical Program Evaluation and Innovation
  • Collaboratively lead the Evaluation and Innovation teams to ensure full clinical consideration of solution and care models chosen for trial testing
  • Collaboratively lead the research team in the trial design, analytic planning and interpretation of data and output
  • Lead partnership relationships with vendors and providers participating in innovative care model adoption incentive programs

This role will challenge your ability to work on an energetic and high visible team working passionately to help ensure our members always get the care that is right for them

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:

• Active Board-Certified physician (MD, DO or equivalent)
• Active/unrestricted State(s) Medical Licensure
• Masters level degree (or higher) in statistics, epidemiology, health services research or a related field
• 10+ years of experience as a clinician (MD, DO or equivalent)
• 10+ years of experience in health plan administration, health services research, quality assurance or comparable experience
• 10+ years of serving as a consultant or leading a team on point for care quality improvement or product development and production
• Deep understanding of health plan medical policies, utilization management processes, and interpretation of data-rich reports related to utilization management programs
• Familiar with the deployment
• Proficient in Excel, PowerPoint, Teams, Outlook and Sharepoint
• Demonstrated ability to understand and efficiently interpret expansive data on clinical performance, program ID Strat (inclusion & exclusion criteria), financial impact data as well as program auditing and compliance review results
• Demonstrated ability to work collaboratively with clinicians, administrators and customers
• Demonstrated ability to drive process standardizations without suppressing creativity
• Demonstrated ability to navigate complex conversations with external partners, customers and providers who may challenge product specifications or analytic methods
• Demonstrated flexibility, agility and the ability to adapt to change while staying organized and maintaining strong relationships

Preferred Qualifications:

• Experience with clinical program design, deployment and/or evaluation in the provider or payer setting
• Experience interacting with leaders across diverse members of the healthcare industry

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $386,500 - $579,500 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.