Job Description

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. The Chief Medical Officer--Aetna Better Health of Oklahoma will serve as a strategic and operational partner to the State CEO, COO, Health Service Officer and other executive team members in Medicaid driving clinical excellence, achieving measurable health outcomes, and supporting quality and medical management in a highly matrixed environment. The CMO will also support national strategic processes and priorities as well as conceptualization, design, and implementation of strategic priorities for Medicaid. The State CMO will be responsible for cost containment outcomes and defined KPI’s and overall growth and success of the plan through effective clinical leadership. Accountable for overall plan results and the delivery of high-quality cost-effective products and services that strategically align to the goals of the State partner. Ensures members get the right health care treatment for their needs, working to eliminate low value care, over and underutilization of health care services in alignment with the Quintuple AIM. Participates with plan leaders in identification and developing the appropriate enterprise and local strategies to fulfill plan business goals and growth imperatives. Provide clinical expertise to shape the integrative model of physical, behavioral, health related resource needs to support holistic care and optimal health outcomes. Primary Job Duties & Responsibilities Develop, implement, support, and promote population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare to establish a sustainable competitive business advantage by supporting the plan goals. Review, interpret and analyze data and trends at State level in: UM, CM, Pop Health and Health Equity in order to identify risks and opportunities for improvement. Serve as clinical executive leader for State regulators, providers, and other key partners. Serve as clinical leader for provider engagement and enablement. Have oversight of the design, development, and deployment of Care Models and review medical care provided to Enrollees and medical aspects of the Provider Contract. Ensure clinical programs are compliant with all national and state regulations including ensuring compliance with State and local reporting laws on communicable diseases, Child Abuse, and neglect. Oversight of the Quality Assessment and Performance Improvement Program (QAPI). Fundamental Components & Physical Requirements The CMO is a member of the plan executive leadership team and must collaborate cross functionally to achieve plan goals including: Serving as a subject matter expert and provide oversight of the design, development, and deployment of Care Management, Utilization Management, Population Health, Health Equity and Quality programs. Collaborating with the Medical Management stakeholders both internally (UM/CM, Pharmacy, Quality, network, compliance, VBS team) and externally (Agency, regulators, providers, community partners, and JOC’s ensuring timely and consistent responses to the needs of members and providers. Building and inspiring a culture of continuous improvement for better quality of care measured by improving HEDIS/STARS outcomes and supporting appropriate utilization of services. Work closely with Quality, Health Equity, and BH integration teams with shared accountability for overall quality outcomes that improve plan ranking among competitors, reduce liquidated damages, and support accreditation activities. Supporting the UM team in predetermination reviews and providing clinical, coding, and reimbursement expertise. Work closely with UM team and Plan clinical leaders to identify and effectively manage emerging utilization trends, large case reviews, and out of state service requests. Serve as clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Support management of medically complicated care and lead collaboration internally and externally to support coordinated care. Partnering with Plan leaders, Network, and provider relations teams to drive differentiated provider engagement/experience. Collaborate with network teams to optimize provider performance, value based arrangements, and strategically expand VBS network. Strong business acumen. Understands and proficient in sharing financial impacts, and market demands. Ability to understand and interpret data (e.g., medical cost trends) and articulate trend and solutions. Use data analytics to inform and influence population health to drive behavior change and expand Aetna's medical management programs to address specific member conditions across the continuum of care. Partner with all HealthPlan based and enterprise leaders to monitor and mitigate emerging cost drivers (MED/ BH/ Rx). Externally facing brand ambassadors; inform and influence all constituents (e.g., providers, state regulators, community, and faith-based organizations). Strong oral and written communication skills in presenting to varied groups including providers, state and local agencies, key stakeholders (community-based organizations, and advocacy groups). Collaborate and partner with SDoH teams to develop strategy to identify, engage, and improve the lives of members identified with known or potential social determinants of Health. Collaborate with and provide subject matter expertise to the product team to arrive at new and innovative products that help achieve business goals. Required Qualifications At least five years’ experience in the health care delivery system e.g., clinical practice and health care industry. At least three years of experience Medicaid and managed care experience. Must be a physician with a current, unencumbered license through the Oklahoma. Board Certification in a recognized specialty including post-graduate direct patient care experience. Preferred Qualifications Demonstrated experience in population health management and managed Care. Passion and ability to influence and drive better outcomes in healthcare delivery. Understanding of Value Based Contracting/Accountable Care and how this relates to improving the quality of care for our members through collaboration with the provider community. Education MD or DO Required Board Certification required in an ABMS or AOA recognized specialty. Regular and reliable attendance. Travel will be required occasionally. Pay Range The typical pay range for this role is: $184,112.50 - $396,550.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | CVS Health We anticipate the application window for this opening will close on: 11/22/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr

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