Chief Medical Officer - UCS Clinical Assessment Review Expert

At United Healthcare, 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 Chief Medical Officer of United Clinical Services (UCS) Clinical Assessment Review Expert (CAREs) team plays a pivotal role in ensuring United Healthcare’s national clinical programs meet key objectives across clinical quality, growth, and financial performance. This position requires a visionary, innovative, and hands‑on clinical and operational leader with national executive presence‑someone who is client‑savvy and thrives on optimizing the value of clinical programs, particularly those related to Utilization Management (UM) activities sponsored by the Lines of Business.

Reporting directly to the National Chief Medical Officer of Medical Management, this executive serves as a strategic business partner, leveraging clinical assets to drive high performance in quality, compliance, affordability, and satisfaction across clients, patients, and providers.

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.

• Serve as an executive leader within Office of Medical Management within UCS with accountability over the CARES team, including executive strategic vision and leadership across all key operations
• Manage a team responsible for monitoring clinical, affordability, and operational outcomes
• Provide strategic leadership in collaboration with operations, Medical Management pillar leads, Healthcare Economics - medical informatics, finance, network and other key matrixed Line of Business (LOB) partners through all phases of relevant UM programs, including Inpatient Concurrent Review, Prior Authorization, and Medical Claims Review as distinct examples
• Work in partnership with enterprise operational, LOB partners, and Value Creation leadership to address gaps & deficiencies for existing clinical programs, as well as helping to inform clinical value for future medical management initiatives
• Support the organization in identifying emerging clinical trends and shaping strategic direction. Collaborate with internal and external partners to publish high impact content focused on improving compliance, quality, and affordability
• Evaluate clinical and other data (e.g., quality metrics, claims data, bed‑day data, usage data) to identify opportunities for improvement of clinical processes
• Develop key messages and talking points for communicating clinical program outcomes to key external stakeholders
• Proactively identify growth opportunities and deliver clinical support to Utilization Management teams, credentialing functions, and delegated entities. Create and maintain strong relationships with key clinical leaders across Optum, UHG, and external delegates
• Participate in and lead key executive meetings including LOB affordability leadership meetings, Value Creation Ideation Front door, and LOB Joint Operating Committee
• Effectively navigate challenging conversations with professionalism and emotional intelligence, particularly when addressing programs that impact compliance, quality, affordability, or involve areas of disagreement. Present clinical findings, remediation strategies, and anticipated outcomes to groups in a clear and impactful manner. Influence development of technical/clinical communications that will be delivered to external audiences (e.g., new clinical policies, programs, processes)
• Discuss oversight findings with internal or external parties (e.g., case managers, other medical directors, clinical providers, physicians)
• Provide feedback to team members and other departments to refine decision making and promote a shared understanding of clinical determinations and outcomes
• Assess and…