National Medical Director, Medical Policy, Medicare Advantage Plans - UnitedHealthcare
Company: UnitedHealth Group
Location: Minnetonka
Posted on: April 15, 2025
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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 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:
Active/unrestricted Medical Degree and License
Board certification approved by the American Board of Medical
Specialties (ABMS/AOBMS)
Prior health plan experience
3+ years in a Medical Policy leadership role
Prior management experience
Deep knowledge of Medicare regulations including Medicare Manuals,
NCDs and LCDs
Experience with Medicare Advantage policies and compliance
Thorough understanding of evidence-based medicine, with extensive
experience in critical review of the medical literature and/or
medical research publications
Demonstrated ability to think strategically, with proven ability to
drive results
Strong critical thinking and analytic skills
Skills in communicating effectively and efficiently (both verbal
and written)
Proficiency working in a matrix environment, with demonstrated
ability in systems thinking and enterprise insight to solve complex
business problems
Proven leadership during organizational change to drive
transformation effectively in a fast-paced environment, while being
adaptable and assisting individuals through the transition
Experience in motivating and influencing others at all levels
within the organization
Demonstrated growth mindset in being open and able to break through
barriers, while having an ability to leverage innovation
Extensive record of performance, by meeting and exceeding
established goals
Strong data analytic skills
Demonstrated ability to make strategic, operational and
administrative decisions in response to emerging conditions and
environmental circumstances
Ability to provide recommendations and insight regarding
improvements to internal and external processes
Ability to manage multiple competing priorities
*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.
Keywords: UnitedHealth Group, Eau Claire , National Medical Director, Medical Policy, Medicare Advantage Plans - UnitedHealthcare, Executive , Minnetonka, Wisconsin
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