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The National Medical Director of Orthopedic and Musculoskeletal Programs is responsible for leading the design, development and oversight of clinical specialty programs to improve the affordability and quality of medical care across musculoskeletal procedures and related therapies, implantable hardware, and DME. The National Medical Director leads a small entrepreneurial team that uses the company's health care analytical tools, medical literature, clinical experience, and provider and member feedback to identify, design and implement clinical programs to lower cost, simplify healthcare delivery and improve quality and outcomes. The team is also accountable for post-deployment review of results. This position reports to the National Medical Director of Specialty Content and Care Pathways in UnitedHealthcare Clinical Services.
This role requires a strategic and critical thinking mindset with the ability to handle multiple priorities as well as the ability to articulate and represent UHC clinical strategy to executive leaders across the enterprise and to external stakeholders.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
For all hires within 30 minutes of an office in Minnesota or Washington, D.C., you'll be required to work a minimum of four days per week in-office.
Primary Responsibilities
- Clinical Strategy Leadership in Program Design and Development
- Possess solid clinical and operational knowledge having worked in the designated medical specialty of Orthopedics
- Oversee the strategy for health plan musculoskeletal specialty programs using knowledge and understanding of the healthcare industry, emerging technology and trends, and current medical specialty guidelines and peer-reviewed literature, incorporating feedback from key stakeholders
- Lead the design of clinical program development for modernizing utilization management and retrospective clinical review programs across the continuum of musculoskeletal procedures, therapies, pain management and related DME to improve health outcomes with a focus on member and provider experience
- Provide leadership and clinical insights for musculoskeletal category activities across the enterprise such as value-based care programs, quality improvement initiatives, and care management
- Process Optimization
- Identify pain points in current prior authorization processes and propose innovative solutions
- Support effective implementation in partnership with teams in clinical operations and technology
- Participate in the development of pilot programs and evaluate performance metrics for automation initiatives
- Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
- Set and review program metrics for continuous enhancements, updates, and improvement
- Data and Technology Proficiency
- Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives
- Direct the healthcare analytics team as they work through hypothesis and problems and synthesize the results and to assure model assumptions are accurate
- Evaluate clinical, quality and claims data to identify opportunities for improvement of clinical programs
- Provide clinical insights and input to guide technology partners in development of large language learning models and technical capabilities for care pathways and bundled authorizations
- Communication, Collaboration and Relationship Building
- Articulate and represent UHC clinical strategy to executive leaders across the enterprise and to external stakeholders and be able to speak clearly on complex problems
- Advocate with leadership across the organization to create better alignment with business segments, network, and functional areas, thereby ensuring internal and external coordination and a unified approach to the market and associated constituents
- Coordinate efforts of clinical, network, operations and HCE teams to support expansion of value-based programs delivered through our providers
- Create and maintain solid relationships with key clinical leaders across the organization
- Clinical Expertise
- Collaborate with the CMO, clinical, network and business leaders on top priorities and goals
- Participate in key clinical committees
- Solicit or respond to input on clinical initiatives
- Influence development of clinical communications that will be delivered to external audiences. (e.g., new clinical policies, programs, processes)
- Participate in the response development and delivery to high level questions, concerns and complaints from regulators, accreditors, legal/risk management, employers, healthcare providers, and other stakeholders
- Discuss clinical program outcomes, data and performance with providers, employers, accreditors and regulators
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications
- Doctorate of Medicine (MD or DO) degree with active/unrestricted medical license in one of more states
- Board certified in Orthopedics or related specialty required
- 10+ years of clinical practice experience required
- 7+ years of progressive healthcare leadership experience managing clinical and cross functional teams
- 5+ years of senior level management experience leading clinical operations in a health plan or managed care environment
- Business training and experience in addition to clinical expertise
- Demonstrated understanding of and experience with managed care functions of utilization management, clinical decision support, post service review, and/or care management functions aligned to evidence-based medicine
- Demonstrated ability to read and understand evidence-based medical literature and how this applies to the development of medical policy and clinical guidelines
- Familiarity with digital health platforms and healthcare data exchange
- Solid strategic thinking and business acumen with the ability to align clinical related strategies and recommendations with business objectives
- Solid analytic and critical thinking skills with proven ability to use clinical, quality and claims data to identify opportunities, inform program design and measure process, clinical and financial outcomes
- Solid history of quickly building relationships, gaining credibility, and partnering with business leaders
- Solid operational focus with demonstrated data analysis / interpretation acumen, project management, change management, and execution skills
- Solid organizational, management, administrative, and human relations skills, and a style which exhibits emotional maturity, leadership, collaboration, and teamwork
- Proven ability to communicate effectively and efficiently (both verbally and written) at multiple levels of large, complex organizations
- Proven ability to drive, lead and to communicate change effectively in a fast-paced environment and be adaptable within the changing environment
- Proven ability to motivate, mentor, and influence others at all levels within the organization
- Demonstrated ability to make strategic, operational, and administrative decisions in response to emerging conditions and environmental circumstances
- Demonstrated ability in systems thinking and enterprise insight to solve complex business problems and solid analytical skills with ability to drive transformational, consumer-centric change and manage long-term programs
- Past success working collaboratively in a highly matrixed environment
Preferred
- Experience in digital health transformation or technology-enabled care models
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $386,500 to $579,500 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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.