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

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.

About the Role

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 includes:

• Clinical Program Governance process and team, charged with ensuring deployed clinical programs represent the best opportunity to improve health, optimize member and provider experience, and reduce unwarranted healthcare spending. The core process (Clinical Program Review (CPR)) evaluates clinical programs annually for performance, design, and alignment with member and health plan needs. This includes:
  • 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
  • Review of AI deployments in the clinical space
• Clinical Program Evaluation – designing trials, planning statistical analyses, and evaluating innovative program and care model deployments, including pragmatic trials, medical policy impact analyses, and evaluation of provider-focused incentives
• Clinical Program Innovation – identifying and vetting top priority clinical solutions and care models for robust pilots, monitoring deployed solutions, and leading internal customer relations as well as vendor and provider relationships

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.

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, including HCE impact assessments on financial impact
  • Work with CPR Committee Chair, Director, team, and stakeholders to maintain disciplined processes for operation, documentation, and communication
  • Manage the CPR team of 5-7 people, operating the Ideation Front Door process, the Clinical Discovery Forum, and the Clinical Program Review in collaboration with program owners, health plan leaders, and Healthcare economics teams
  • Ensure follow-up with clinical program owners and operations teams to implement CPR recommendations (or understand why not)
• Clinical Program Evaluation and Innovation:
  • Collaboratively lead the Evaluation and Innovation teams to ensure full clinical consideration of solutions and care models chosen for trial testing
  • Lead the research team in 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

Requirements

• Active Board-Certified physician (MD, DO or equivalent)
• Active/unrestricted State(s) Medical Licensure
• Master’s 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 experience serving as a consultant or leading a team on 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
• Familiarity with deployment of clinical 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 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

Pay

Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications. The salary for this role will range from $386,500 - $579,500 annually based on full-time employment.

Benefits

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