C&S CMO New Mexico

About the role

Lead teams to help New Mexico's most vulnerable population lead healthier and happier lives as the Chief Medical Officer (CMO) for UnitedHealthcare Community Plan of New Mexico. This role is accountable for ensuring over half a million New Mexicans receiving Medicaid benefits achieve high-quality clinical outcomes, exceptional quality performance ratings, and high member and provider satisfaction scores. The CMO drives healthcare transformation by advancing a clinical model that engages underserved individuals in a population health framework, supported by integrated community care teams and over 3,000 providers in a value-based payment model.

This position reports to the Health Plan's Chief Executive Officer (CEO) and collaborates with Enterprise Clinical Services (ECS) staff, including the regional CMO, and other market and regional shared service partners to implement New Mexico's managed Medicaid programs. You'll enjoy the flexibility to work remotely from anywhere within the U.S., though hires in the Minneapolis or Washington, D.C. area will be required to work in the office a minimum of four days per week.

Responsibilities

• Quality and Affordability: Champion healthcare affordability projects to ensure members receive the best possible care. Serve as the clinical leader for local healthcare affordability initiatives and a primary stakeholder in clinical model operations, including Person-Centered Care Models (PCCM), New Mexico Delivery System Transformation, and Value-Based Program (VBP) relationships. Oversee the design, collaboration, and implementation of new or improved Models of Care programs as defined by the State contract or CMS. Lead or participate in the local market peer review process and regional UHC Peer Review committee.
• Clinical Excellence: Support HEDIS and STARs data collection, CAHPS improvement strategy, and drive Health Plan accreditation activities. Ensure strong performance in HEDIS, Stars, and State-defined measures to support advanced payment models. Act as an improvement catalyst for quality-related efforts, including CMS Star initiatives. Communicate new focus areas and measure/process changes to providers. Support Clinical Quality initiatives, peer review processes, and participate in or lead committees such as Physician Advisory Committees (PAC) and Quality Management Committee (QMC).
• Relationship Equity and State Compliance: Maintain a strong working knowledge of government mandates and provisions for the New Mexico Medicaid market. Implement and maintain compliant clinical programs and procedures across the enterprise. Engage with external constituents, including consumers, physicians, medical societies, hospitals, regulators, and market-based collaboratives. Serve as the outward face to State regulators and provide clinical thought leadership with external entities.
• Innovation: Lead the clinical interface with care providers and UHC network management colleagues to transform the health system. Drive PCCM/Accountable Care Community growth through practice identification, target setting, and implementation. Oversee the entire clinical model within the market, including knowledge of VBP contracting variants for Medicaid, such as UHC's Accountable Care Platform, clinical practice transformation, and integrated service models (medical, behavioral, and social risk). Create a culture of diversity and inclusion to reduce health disparity.
• Growth: Deliver a clinical value proposition focused on quality, affordability, and service to support the growth of the C&S Health Plan. Review and edit communication materials and represent the voice of the market-based customer in program design. Contribute to RFP/re-procurement activities and promote positive relations with State/local regulatory authorities and medical societies.
• Grievance and Appeals: Maintain an active liaison with ECS Grievance & Appeals and lead a clinical team overseeing or representing the Local C&S plan at state-level fair hearings. Provide leadership in evaluating requests for Independent Reviews and formal Provider Complaints.

Qualifications

• Active and unrestricted New Mexico Medical License as a Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
• Must reside in New Mexico.
• Board Certified in an ABMS/AOBMS specialty in one or more of the following: Internal Medicine, Family Medicine, Pediatrics, OB/GYN, or Psychiatry.
• Current DEA licensure and prescriptive authority in the state where applicable.
• 5+ years of clinical practice experience.
• 2+ years of Quality Management experience.
• Solid knowledge of the managed care industry and the Medicaid line of business, including Utilization Management.
• Driver's License and access to reliable transportation.

Skills

• Ability to build and lead teams that prioritize organizational success, provide coaching, and manage performance.
• Ability to inspire superior performance, align teams with the company's mission, and focus on customer service.
• Strong decision-making skills driven by disciplined, fact-based analysis.
• Ability to execute with discipline and urgency, drive operational excellence, and manage financial performance.
• Skilled General Manager with clinical expertise, capable of leading within the "C" Suite.
• Ability to drive change and innovation by challenging the status quo and fostering a culture of continuous improvement.
• Proven ability to model and demand integrity and compliance.
• Ability to develop relationships with New Mexico State government clinical leadership, network physicians, and community providers.
• Visibility and involvement in the medical community.
• Ability to function successfully in a matrix organization and exhibit UnitedHealth Group's culture.
• Lead and influence teams by fostering collaboration, driving engagement, and leveraging diversity and inclusion.
• Develop and mentor others while building self-awareness of strengths and development needs.
• Influence and negotiate effectively to achieve win-win solutions.
• Communicate and present effectively to both clinical and non-clinical audiences.
• Lead change and innovation by demonstrating emotional resilience and promoting a culture that thrives on change.
• Drive sound, disciplined decisions using financial knowledge and data to manage the business.
• Manage execution by delegating work, setting clear expectations, and exceeding goals.

Preferred Qualifications

• Master's degree in Public Health, Business Administration, and/or Healthcare Administration.
• Proficiency with Microsoft Office applications.
• Familiarity with current medical issues and practices.
• Proven excellent interpersonal communication and presentation skills.
• Proven project management skills.
• Proven strategic thinking with the ability to communicate a vision and drive results.
• Proven creative problem-solving skills.
• Proven ability to develop relationships with network and community physicians.