Senior Medical Director of Clinical Program Governance and Standardization - Remote

Senior Medical Director Of Clinical Program Governance & Standardization

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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 is charged with ensuring 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 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 (~40/year)
• UHC's participation in cross industry effort to advance standards and reduce friction for members and providers. This work is currently most intensely focused on ensuring UHC achieves its clinical standardization commitment to AHIP. The work involves collaborating with competitor teams and legal oversight teams to reduce friction-generating differences in UM processes across the industry

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.

Primary Responsibilities:

• Bring a seasoned clinical lens to the review of clinical programs to ensure the clinical model is evidence-based and 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 3-5 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)

Cross Industry Standardization

• Participate in cross-industry team meetings and contribute UHC's perspective to support efficient advancement of standardization efforts, under the oversight of our UHC and UHG legal partners
• Develop, review and refine standardization documents, consulting regularly with UHC SMEs to ensure that our contribution fully reflects our perspective and that internal team leaders have an opportunity to weigh in when appropriate

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:

• 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

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). The salary for this role will range from $292,300 - $438,500 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.

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.