Job Description

**This is a remote based (work at home). Candidate must reside, and be licensed, in the state of Florida.**

The CMO Aetna Better Health of Florida has budget accountability for the Market/State they support. They will serve as a strategic and operational partner to the State CEO, COO, and HSO in Medicaid driving clinical excellence, quality and medical management in a highly matrixed environment and having shared operational responsibilities with other members of the plan C-suite.. The CMO time commitment would be ~15% thought leadership and 85% accountability for plan clinical outcomes. CMO will also support national strategic processes and priorities as well as conceptualization, design and implementation of strategic priorities for Medicaid. The CMO Aetna Better Health of Florida 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.
• Ensures members get the right health care treatment for their needs, working to eliminate low value care, over and under utilizations 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, and social determinants of health arriving at a whole person care.

The CMO Aetna Better Health of Florida is a key member of the Market/health plan executive leadership team and collaborates cross functionally with all Market colleagues. The CMO’s contributions to the Market’s business, strategic and clinical operations goals:

• Clinical Operations: UM and CM operational goals and compliance-driven targets
• Quality Improvement: goals including achieving successful accreditation and, HEDIS and state articulated performance measures
• Total cost of care reduction Targets achieved through value based arrangements, population health programs, and high-dollar management protocols
• Specialized Care Planning: Case Management and Disease Management expertise.
• Ability to collaborate with all stakeholders, understanding the guidelines/basics (how to access), the requirements, opportunities to shape within the scope in the role as a Health plan medical director. (*)
• Have oversight of the design, development, and deployment of Care Models and Population Health programs across markets and lines of business.
• Act as a subject matter expert to fellow team members in clinical design of Care Model and Population Health/Health Equity programs and ability to shape specialized care planning strategies for medically complex patients to improve care outcomes.
• Collaborate with local provider systems and influence care management programs.
• Analytics-Oriented Care: Ability to understand and interpret data (e.g., medical cost trends) and articulate trend and solutions. Using 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.
• Ability to manage complex cases and client relationships with plan sponsors. (*)
• Derive insights from analytics to provide better care and deliver services more efficiently.
• Provide medical consultation to analytics and technology-based teams to steer effectiveness of analytics applications and platforms.
• Virtual and Physician Engagement: Leveraging multi-channel platforms and digital technology to interface with internal and external customers. 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.
• End to End Market Understanding: Strong business acumen. Understands and proficient articulating products, financial impacts, and market demands. Must achieve in first 3 months, a thorough working knowledge of state Contracts governing the populations served (currently Medicaid and CHIP Contracts).
• Externally facing brand ambassadors; inform and influence all constituents (e.g. providers, broker/consultants, employers, state and federal government regulators).
• Lead clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
• Communications: Both oral and written skills and comfort in presenting to varied groups.
• Collaborating with the Medical Management staff 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 members and providers.
• Participate in presentations and meetings with providers, state and local agencies, key stakeholders (community based organizations, and advocacy groups) providing a compelling value proposition behind the partnerships.
• Executing predetermination reviews, reviews of claim determinations, 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 service requests.
• Building and inspiring a culture of continuous improvement for better quality of care. Measured by increasing HEDIS/STARS outcomes. Work closely with Quality, Health equity, and BH integration teams and have shared accountability for overall quality outcomes that improve plan ranking among competitors, reduce liquidated damages, and support accreditation activities.
• Will collaborate with and provide subject matter expertise to the product team to arrive at new an innovative products that help achieve business goals.
• Collaborate and partner with SDoH teams to identify, engage, and improve the lives of members identified with known or potential social determinants of Health.
• Partner with all pan based and enterprise leaders to monitor and mitigate emerging cost drivers (MED/ BH/ Rx)

Pay Range
The typical pay range for this role is:

• Minimum: 162,600
• Maximum: 348,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• 5+ years clinical experience
• 5+ years experience in medical leadership, preferably health plan.
• Active Florida medical license without encumbrances.

Preferred Qualifications

• Managed care, utilization management, quality, care management
• Strategy design and implementation
• Ability to motivate teams, work collaboratively across a matrixed organization.
• Travel will be required occasionally.

Education

• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
• Active and current Florida state medical license without encumbrances or ability to obtain medical license in Florida is a job requirement for this position.
• Advanced business or clinical degree preferred, such as MBA, MPH, MPP, CPE

Business Overview
Aetna, a CVS Health Company, a Fortune 4 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.

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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

https://jobs.cvshealth.com/job/16990155/chief-medical-officer-aetna-better-health-of-florida/