Chief Medical Officer - UCS Clinical Assessment Review Expert - Remote Eligible

Chief Medical Officer Of United Clinical Services (UCS) Clinical Assessment Review Expert (CAREs) Team

The Chief Medical Officer of United Clinical Services (UCS) Clinical Assessment Review Expert (CAREs) team plays a pivotal role in ensuring UnitedHealthcare's national clinical programs meet key objectives across clinical quality, growth, and financial performance. This position requires a visionary, innovative, and hands-on clinical and operational leader with national executive presence-someone who is client-savvy and thrives on optimizing the value of clinical programs, particularly those related to Utilization Management (UM) activities sponsored by the Lines of Business. Reporting directly to the National Chief Medical Officer of Medical Management, this executive serves as a strategic business partner, leveraging clinical assets to drive high performance in quality, compliance, affordability, and satisfaction across clients, patients, and providers.

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

For all hires within 30 minutes of an office in Minnesota or Washington, D.C., you'll be required to work a minimum of four days per week in-office.

Primary Responsibilities:

Serve as an executive leader within Office of Medical Management within UCS with accountability over the CARES team, including executive strategic vision and leadership across all key operations

Manage a team responsible for monitoring clinical, affordability, and operational outcomes

Provide strategic leadership in collaboration with operations, Medical Management pillar leads, Healthcare Economics - medical informatics, finance, network and other key matrixed Line of Business (LOB) partners through all phases of relevant UM programs, including Inpatient Concurrent Review, Prior Authorization, and Medical Claims Review as distinct examples

Work in partnership with enterprise operational, LOB partners, and Value Creation leadership to address gaps & deficiencies for existing clinical programs, as well as helping to inform clinical value for future medical management initiatives

Support the organization in identifying emerging clinical trends and shaping strategic direction. Collaborate with internal and external partners to publish high impact content focused on improving compliance, quality, and affordability

Evaluate clinical and other data (e.g., quality metrics, claims data, bed-day data, usage data) to identify opportunities for improvement of clinical processes

Develop key messages and talking points for communicating clinical program outcomes to key external stakeholders

Proactively identify growth opportunities and deliver clinical support to Utilization Management teams, credentialing functions, and delegated entities. Create and maintain strong relationships with key clinical leaders across Optum, UHG, and external delegates

Participate in and lead key executive meetings including LOB affordability leadership meetings, Value Creation Ideation Front door, and LOB Joint Operating Committee

Effectively navigate challenging conversations with professionalism and emotional intelligence, particularly when addressing programs that impact compliance, quality, affordability, or involve areas of disagreement. Present clinical findings, remediation strategies, and anticipated outcomes to groups in a clear and impactful manner. Influence development of technical/clinical communications that will be delivered to external audiences (e.g., new clinical policies, programs, processes)

Discuss oversight findings with internal or external parties (e.g., case managers, other medical directors, clinical providers, physicians)

Provide feedback to team members and other departments to refine decision making and promote a shared understanding of clinical determinations and outcomes

Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives

Identify and implement development resources aligned with evolving business needs and regulatory requirements. Serve as a dyad partner with the Vice-President of Clinical Strategy and Operations within Medical Management.

Serve as a delegate to the National CMO of Medical Management for broader strategic decisions

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:

Doctor of Medicine (MD or DO) degree with unrestricted medical license

3+ direct collaboration with market and national business unit presidents, health plan chief operating officers, and network leadership to drive strategic alignment, resolve facility-level escalations, and advance operational excellence

3+ years of experience delivering clinical and operational insights to executive audiences, with a solid ability to translate complex data into actionable strategies

10+ years of clinical practice experience required

5+ years of progressive National leadership experience managing teams, specifically Utilization Management teams

5+ years of managed care experience across the continuum of care including acute and chronic condition management, utilization management, and preventative services required

Demonstrated expertise in applying Utilization Management principles across the payor continuum, including pre-service, concurrent review, post-acute care, and post-service medical management functions.

Proven track record of success across healthcare delivery systems, including utilization management, case management, disease management, quality management, and peer review

A solid business foundation complementing clinical expertise-recognized as a key success factor for this role

Skilled in managing provider and client-facing relationships, with a focus on customer engagement and satisfaction

Proficient in applying evidence-based clinical decision-making tools such as InterQual

Well-versed in URAC and NCQA Utilization Management standards and requirements. Exceptional presentation skills, with the ability to effectively engage both clinical and non-clinical audiences

Solid operational orientation, demonstrated through expertise in data analysis and interpretation, project management, change leadership, and execution

Proven success collaborating within highly matrixed environments, navigating complex organizational structures with ease

Strategic thinker with robust business acumen, capable of aligning clinical strategies and recommendations with overarching business goals

Flexible and adaptive collaborator, skilled at working with key stakeholders to establish direction and drive outcomes

Recognized ability to quickly build credibility, influence decision-making, and foster partnerships across staff, business leaders, and the clinical community. Solid belief in evidence-based medicine