National Medical Director of Orthopedic and Musculoskeletal Programs - UHC

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The National Medical Director of Orthopedic and Musculoskeletal Programs 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 Responsibilities:

• Clinical Strategy Leadership in Program Design and Development
  • Possess solid clinical and operational knowledge having worked in the designated medical specialty of Orthopedics
  • Oversee 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 stakeholders
  • Lead 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 experience
  • Provide leadership and clinical insights for musculoskeletal category activities across the enterprise such as value-based care programs, quality improvement initiatives, and care management
• Process Optimization
  • Identify pain points in current prior authorization processes and propose innovative solutions
  • Support effective implementation in partnership with teams in clinical operations and technology
  • Participate in the development of pilot programs and evaluate performance metrics for automation initiatives
  • Build and develop relationships across teams to ensure effective feedback loops and that deliverables are met
  • Set and review program metrics for continuous enhancements, updates, and improvement
• Data and Technology Proficiency
  • Assess and interpret complex financial and clinical data to evaluate feasibility of proposed initiatives
  • Direct the healthcare analytics team as they work through hypothesis and problems and synthesize the results and to assure model assumptions are accurate
  • Evaluate clinical, quality and claims data to identify opportunities for improvement of clinical programs
  • Provide clinical insights and input to guide technology partners in development of large language learning models and technical capabilities for care pathways and bundled authorizations
• Communication, 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 problems
  • Advocate 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 constituents
  • Coordinate efforts of clinical, network, operations and HCE teams to support expansion of value-based progra