C&S CMO New Mexico

Texas Health Institute; Albuquerque, Northern (NM, KY); Hybrid; USD 250,000 - 350,000; Full time

Job summary

UnitedHealthcare Community Plan of New Mexico seeks a Chief Medical Officer to lead clinical strategy, quality outcomes, and value-based care initiatives across the Medicaid population.

Reporting to the CEO, the CMO will collaborate with ECS and state regulators, drive PCCM and population health models, and champion affordability while delivering high-quality care for New Mexico's underserved communities.

Job description

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. Ready to make a difference? Join us to start Caring. Connecting. Growing together

Are you ready to seize this opportunity to do your greatest work as a physician by leading teams to help New Mexico's most vulnerable population lead healthier and happier lives? UnitedHealthcare is creating opportunities in every corner of the healthcare marketplace to improve lives while building careers.

Innovation isn't about another gadget; it's about transforming the health care industry through integrated clinical models and value-based provider programs that combine to deliver the quadruple aim statewide in New Mexico. That means continuous career growth opportunities for you. While we support you with the latest tools, advanced training, and the combined strength of high caliber co-workers, you can continue following the path of your life's best work.SM of Chief Medical Officer (CMO) for UnitedHealthcare Community plan of New Mexico.

This Community and State (C&S) Health Plan serves over half a million New Mexicans receiving Medicaid benefits. The CMO role is accountable for ensuring these individuals achieve high quality clinical outcomes as evidenced by exceptional quality performance ratings, as well as high member and provider satisfaction scores. Furthermore, healthcare transformation is a priority focus of the CMO by continuously advancing a clinical model that engages underserved individuals in a population health model that is 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 has dotted line relationships to the C&S CMO as well as to the Enterprise Clinical Services (ECS) Regional CMO. The CMO's primary responsibilities are directed towards local C&S plan activities as defined by the Health Plan's CEO. The CMO collaborates with ECS staff including the regional CMO, and other market and regional shared service partners to implement the State of New Mexico's programs for its managed Medicaid Program. Activities support national, regional, and local business goals tailored for the New Mexico Medicaid market.

Primary Responsibilities:

• Quality and Affordability - The Health Plan CMO has primary responsibility and accountability for quality medical outcomes and performance while championing healthcare affordability projects that ensure members receive the best possible care. This requires a close working relationship with the State's clinical leadership team, ECS operations teams and with UnitedHealthcare's national healthcare economics team. The CMO serves as the clinical leader for healthcare affordability initiatives in the local market. Additionally, the CMO is a primary stakeholder in clinical model operations including Person-Centered Care Models (PCCM), New Mexico Delivery System Transformation and Value Based Program (VBP) relationships. This includes the design, collaboration, and implementation of new and or improved Models of Care programs such as those defined by the State contract, by Centers for Medicare and Medicaid Services (CMS). The CMO has oversight responsibility of the local market peer review process as defined by the State, as well as participating in or leading the regional UHC Peer Review committee.
• Clinical Excellence - The New Mexico Health Plan CMO supports the HEDIS and STARs data collection process, CAHPS improvement strategy, and drives Health Plan accreditation activities. The CMO also ensures strong HEDIS, Stars and State defined performance measures results to support all advanced payment models. The CMO acts as an improvement catalyst for all quality-related efforts including Center for Medicare and Medicaid Services Star initiatives. Communicates to providers on new focus and measure/process changes. Supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues; participates or leads Physician Advisory Committees (PAC); Quality Management Committee (QMC) and other associated quality focused committees.
• Relationship Equity and State Compliance - The Plan CMO maintains a strong working knowledge of all government mandates and provisions for the New Mexico Medicaid market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. The CMO must be effectively engaged with external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaborative. The CMO will work collaboratively in these activities with ongoing ECS initiatives under the aegis of ECS Regional CMO. The Plan CMO will be the outward face to State regulators based upon Contract requirements and direction of Plan President. The CMO provides clinical thought leadership with external entities, to include the State.
• Innovation - The Plan CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system. Primary local responsibility is to drive PCCM/Accountable Care Community (New Mexico's Patient Centered Medical Home) growth through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership during regular Joint Operating Committees (JOCs.) CMO is accountable for oversight of the entire clinical model (end to end) within the market. Knowledge of VBP contracting variants for Medicaid is an essential secondary responsibility that includes but not limited to, UHC's Accountable Care Platform, clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and