Senior Medical Director of Clinical Program Governance and Standardization - Remote

Responsibilities

• Support and drive key clinical program governance, clinical standardization, and clinical evidence alignment processes.
• Evaluate ~50 clinical programs annually for program performance and design as well as alignment with member and health plan needs.
• Optimize clinical program investments to reflect best opportunities for improving health, enhancing experience, and reducing unwarranted spending.
• Collaborate with competitor teams and legal oversight teams to reduce friction-generating differences in UM processes across the industry.
• Participate in cross-industry team meetings and contribute UHC's perspective to support efficient advancement of standardization efforts.

Requirements

• 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.

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.

Skills

• Seasoned clinical lens to the review of clinical programs.
• Ability to 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.
• 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.

Benefits

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

Pay

The salary for this role will range from $292,300 - $438,500 annually based on full-time employment.

Schedule

No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

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.