Community and State Health Plan Chief Medical Officer - Washington - Remote at UnitedHealthcare[...]

Itlearn360; Renton (WA); Remote; USD 278,000 - 418,000; Full time

Job summary

A leading health care company is seeking a Chief Medical Officer for its Washington health plan, with responsibilities that include ensuring clinical excellence, improving member experience, and compliance with regulations. The role encompasses leadership in innovating health system transformation and fostering partnerships while maintaining quality care. Candidates should hold an active medical license in Washington, with strong clinical expertise and proven leadership abilities.

Qualifications

• Proven ability to drive improvements and deliver value to members.
• Experience with innovative payment models and diverse care settings.
• Strong experience in managed care and health disparities.

Responsibilities

• Responsible for health care quality, efficiency, and achieving performance targets.
• Lead efforts to transform the health system and engage with external stakeholders.
• Manage staff and contribute to a positive workplace culture.

Skills

Leadership

Communication

Problem-solving

Data-driven decision making

Clinical expertise

Knowledge of managed care

Education

Active Medical License in Washington

Board Certification

Tools

Microsoft Office

Job description

Community and State Health Plan Chief Medical Officer - Washington - Remote job at UnitedHealthcare. Renton, WA. 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The C&S Plan Chief Medical Officer has accountability for ensuring that Washington health plan, Enterprise Clinical Services (ECS) and UnitedHealthcare (UHC) initiatives focusing on clinical excellence, quality improvement, member experience, appropriate utilization, affordability, health system transformation including provider network, compliance with regulatory mandates, growth, and other focused improvements are implemented and successfully managed to achieve goals. This position reports to the Washington C&S health plan Chief Executive Officer and has a dotted line relationship to the C&S West National Chief Medical Officer. The primary responsibilities are directed towards C&S plan activities as defined by the C&S plan CEO. The WA C&S CMO collaborates with other health plan leadership and enterprise clinical services to support and implement programs that meet C&S health plan, ECS, and UHC goals. If located in Washington, you will have the flexibility to work remotely.*

Primary Responsibilities

1. Quality and Affordability - Responsible for health care quality, efficiency, customer and provider satisfaction results, achieving performance targets for the Washington C&S plan. This includes working with regional and national programs within UnitedHealthcare, Optum, and UnitedHealth Group, overseeing clinical models, collaborating with community agencies, and implementing health care improvement initiatives.
2. Clinical Excellence - Work with clinical leaders to improve quality and promote evidence-based care. Develop and maintain quality and utilization management programs, oversee quality measurement programs like HEDIS and Stars, and ensure compliance with regulations and accreditation requirements.
3. Relationship Equity and State Compliance - Maintain knowledge of government mandates and work across the enterprise to ensure compliant clinical programs. Engage with external stakeholders such as members, physicians, hospitals, regulators, and community groups.
4. Innovation - Lead efforts to transform the health system, collaborate on social determinants of health, and expand value-based provider partnerships.
5. Growth - Support growth activities by delivering clinical value, reviewing communications, and representing the market in program design and regulatory relationships.
6. Focused Improvement - Identify opportunities for improvement, participate in regional reviews, and oversee clinical teams and services.
7. Grievances and Appeals - Act as a liaison for state-level fair hearings and appeals processes.
8. Human Capital - Manage staff and contribute to a positive workplace culture.

Skills and Experiences

• Proven ability to drive improvements, make data-driven decisions, and deliver value to members.
• Leadership skills to foster teamwork, mentor colleagues, and influence stakeholders.
• Clinical expertise across diverse care settings and experience with innovative payment models.
• Strong communication, negotiation, and problem-solving skills.
• Knowledge of managed care, Medicaid, and health disparities.
• Active/unrestricted Medical License in Washington, Board Certification, and clinical practice experience.
• Proficiency with Microsoft Office and data analysis skills.
• Driver’s License and reliable transportation.

Compensation ranges from $278,000 - $417,500, including benefits, incentives, and stock options. UnitedHealth Group is committed to diversity, equity, and inclusion, and is an Equal Employment Opportunity employer. Candidates must pass a drug test prior to employment.