National Medical Director, Medical Policy, Medicare Advantage Plans - UnitedHealthcare

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.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

This opportunity is an important clinical leadership position reporting to the Chief Medical Officer for Clinical Policy. The National Medical Director for Medical Policy is responsible for diverse functions within the organization and represents the UHC Medical Policy Department. In this role, the individual will:

• Provide Medical Director oversight in the development and annual review of Medicare Advantage and Commercial Medical Policies, requiring:
  
  
  
  • a high level of proficiency in analyzing the medical literature
  • proven skills in synthesis and integration of information from multiple resources
  • a strong understanding of research study design and quality of clinical evidence
  
  
  
  
• Oversee and manage the team that implements Medicare and Retirement Medical Policies with a broad range of internal and external partners
• Serve as Subject Matter Expert and provide guidance to the Medical Policy team and other areas of the organization in matters related to Medical Policy, Medicare and research of the Clinical Evidence
• Monitor regulatory changes as well as established and new LCDs, NCDs, LCAs to ensure our processes and policies drive timely, full compliance
• Support the UHC Compliance and Regulatory Teams with activities related to routine and ad hoc CMS audits, participating and presenting materials to CMS as needed
• Support quality accreditation requirements (e.g., NCQA; CMS) for Clinical Policy, including the integration of clinical input on Medical Policies from participating network providers
• Deliver high value and quality across the organization through 'best in class' Medical Policies that serve as the foundation of several clinical programs
• Actively engage in training activities on new or significantly revised Medical Policies
• Remain up-to-date on new developments at the intersection of science, technology, analytics and business to drive clinical innovation and policy transformation
• Monitor healthcare trends in the pipeline management of new Medical Policies
• Establish business relationships across teams to build effective feedback processes and ensure deliverables are met
• Collaborate to align goals and strengthen partnerships across key stakeholders:
  
  
  
  • Internal - including UHG Medical Affairs, External Affairs, Clinical Operations, Clinical Pharmacy, Behavioral Health and all Lines of Business
  • External - including medical societies and organizations, academic research centers in basic medical sciences and clinical research and centers for health policy research
  
  
  
  
• Identify priorities through data and advanced analytics research
• Analyze medical and clinical evidence; critically assess the scientific research and real-world outcomes to develop objective and unbiased polices in order to drive value for our members, providers and plan sponsors
• Participate in clinical decision-making on medical policies and clinical programs, in conjunction with subject matter experts, clinical case review staff and other stakeholders in Value Creation and Affordability Teams
• Assist with executive and media inquiries related to Medical Policy
• Provide support in socializing policies and implementing programs
• Focus on increased transparency and administrative simplification in policy development that will streamline the UM process
• Support internal and external communication strategies for new and updated Medical Policies
• Coordinate organizational procedures for optimized efficiency and productivity
• Share managed care/payer industry knowledge regarding medical policy and utilization management experience
  
  

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:

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $191,800 to $364,800 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.