[Hiring] Senior Medical Director of Clinical Program Governance and Standardization @UnitedHealth Group

Role Description

The UHC Senior Medical Director of Clinical Program Governance & Standardization is part of the UCS Clinical Evidence Group. This physician is responsible for supporting and driving key clinical program governance, clinical standardization, and clinical evidence alignment processes in close collaboration with the National CMO of the UCS Clinical Evidence Group. The portfolio of efforts for which the incumbent will provide support, oversight, and leadership includes:

• The UHC Clinical Program Governance process, which ensures deployed clinical programs are clinically sound, effective, carefully monitored, and advance enterprise goals.
• The core process (Clinical Program Review (CPR)) evaluates ~50 clinical programs annually for program performance and design as well as alignment with member and health plan needs.
• The process aims to optimize clinical program investments, ensuring that the portfolio reflects the best opportunity to improve health, enhance experience, and reduce unwarranted spending.
• Support of early program development through the clinical program Ideation Front Door (IFD) process.
• Clinical review of vendor candidates for the UHC & Optum Hub and Store (~40/year).
• UHC’s participation in cross-industry efforts to advance standards and reduce friction for members and providers.

The incumbent will report to the National CMO of the Clinical Evidence Group. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Qualifications

• Masters level degree (or higher) in statistics, epidemiology, health services research or a related field.
• Board certified physician in an ABMS/AOBMS Specialty.
• Active/unrestricted U.S. Medical Licensure.
• 5+ years of experience as a clinician (MD, DO or equivalent).
• 3+ years of experience in health plan administration, health services research, quality assurance or comparable experience.
• 3+ years 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.
• 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 solid relationships.

Requirements

• 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.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

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.

Company Description

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. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.