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.The National Medical Director of Musculoskeletal Health 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 ResponsibilitiesClinical Strategy Leadership in Program Design and Development Possess solid clinical and operational knowledge having worked in the designated medical specialty of OrthopedicsOversee 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 stakeholdersLead 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 experienceProvide leadership and clinical insights for musculoskeletal category activities across the enterprise such as value-based care programs, quality improvement initiatives, and care managementProcess Optimization Identify pain points in current prior authorization processes and propose innovative solutionsSupport effective implementation in partnership with teams in clinical operations and technologyParticipate in the development of pilot programs and evaluate performance metrics for automation initiativesBuild and develop relationships across teams to ensure effective feedback loops and that deliverables are metSet and review program metrics for continuous enhancements, updates, and improvementData and Technology Proficiency Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiativesDirect the healthcare analytics team as they work through hypothesis and problems and synthesize the results and to assure model assumptions are accurateEvaluate clinical, quality and claims data to identify opportunities for improvement of clinical programsProvide clinical insights and input to guide technology partners in development of large language learning models and technical capabilities for care pathways and bundled authorizationsCommunication, 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 problemsAdvocate 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 constituentsCoordinate efforts of clinical, network, operations and HCE teams to support expansion of value-based programs delivered through our providersCreate and maintain solid relationships with key clinical leaders across the organizationClinical Expertise Collaborate with the CMO, clinical, network and business leaders on top priorities and goalsParticipate in key clinical committeesSolicit or respond to input on clinical initiativesInfluence 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