CMO - Community Plan of New York

Requisition Number: 2360639
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.
This is a rare opportunity to lead clinical strategy and performance for one of the largest and most complex Medicaid health plans in the country. The Chief Medical Officer (CMO) will shape how care is delivered to hundreds of thousands of New Yorkers, with direct accountability for medical cost trends, quality outcomes, and value-based provider performance.
The CMO is the senior clinical executive for UnitedHealthcare Community Plan of New York and a key member of the executive leadership team. This role owns the clinical performance of the health plan, including total cost of care, quality, provider results, and clinical relationships with New York State.
This is a true operating role. Success requires a physician leader who can translate data into action, influence providers and internal partners, and deliver measurable performance improvement at scale across a complex, matrixed organization.
If you are NY state based, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:

• Medical cost management and affordability
  • Own and lead the clinical strategy to improve medical cost trend across all lines of business
  • Identify the highest impact drivers of cost, including inpatient, outpatient, emergency department, post-acute, and pharmacy spend
  • Use data and analytics to identify actionable trends, prioritize interventions, measure outcomes, and drive fact-based decision making
  • Partner with internal and external stakeholders to implement clinical programs that reduce unnecessary utilization and improve care delivery
  • Deliver clinical and financial performance, including total cost of care, quality incentive capture, and improvement in documentation and risk capture
• Quality and clinical performance
  • Partner with quality leadership to improve performance on HEDIS, P4P measures, CAHPS, and other key quality indicators
  • Translate quality priorities to convert performance gaps into actionable provider and operational strategies
  • Support accreditation readiness and sustained clinical excellence
  • Ensure alignment between affordability initiatives and quality outcomes
• Provider partnership and value-based care
  • Drive provider performance in cost and quality through data transparency, clinical engagement, and value-based partnerships
  • Partner with network leadership and UHN to expand and strengthen value-based care models
  • Lead high impact engagements with hospitals, FQHCs, ACOs, large physician groups, health homes, and other priority partners.
  • Influence physician behavior and clinical workflows to improve outcomes, utilization, and member experience
• Regulatory and state clinical leadership
  • Maintain strong working knowledge of New York Medicaid managed care requirements and ensure compliant clinical oversight.
  • Build trusted relationships with state clinical leadership and represent the health plan credibly in clinical discussions with regulators and external stakeholders
  • Provide clinical oversight of medical necessity determinations, appeals/fair hearing clinical issues, and other physician-level governance responsibilities as required
• Clinical governance and matrix leadership
  • Chair the Quality Improvement Committee and lead clinical governance across the organization
  • Ensure solid oversight of clinical policies, guidelines, and standards of care
  • Partner closely with the Health Services Director and clinical operations leadership to triage issues, remove barriers, strengthen execution, and maintain regulatory readiness
  • Lead through influence in a matrixed environment and establish clear accountability and alignment around clinical priorities and performance outcomes
• Population health and innovation
  • Advance population health strategies to improve outcomes for complex Medicaid populations
  • Address social drivers of health and reduce disparities in access, quality, and outcomes
  • Identify and implement data-driven clinical programs that improve affordability, quality, and member experience
  • Promote a culture of innovation, accountability, and continuous improvement

What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
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:

• MD or DO with active, unrestricted New York physician license, or ability to obtain prior to start; New York-based practice familiarity strongly preferred.
• Active board certification in an ABMS or AOA/AOBMS specialty.
• 5+ years of post-residency clinical practice experience.
• Significant physician leadership experience in managed care, population health, or a risk-bearing provider organization
• Solid understanding of Medicaid managed care, value-based care, and population health principles
• Demonstrated success improving medical cost trend, utilization, or total cost of care
• Proven ability to influence providers and deliver results in a matrixed organization
• Proven solid data fluency and ability to translate insights into action
• Proven executive presence with solid communication and problem-solving skills

Preferred Qualifications:

• Advanced degree in business, public health, or medical management
• Experience in New York Medicaid managed care
• Experience with HEDIS, P4P programs, and accreditation processes
• Experience working with large provider systems, FQHCs, ACOs, or integrated delivery networks
• Experience in physical and behavioral health integration
• Experience using AI-enabled tools to improve communication, decision-making, or clinical operations

*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 $292,300 to $438,500 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.