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Chief Medical Officer, Duals/Special Needs Plans

Hartford, CT, USA | CVS Health

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    General Management
    Biotech/R&D/Science
  • Experience:
    7-10 years
Job Description:
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CVS Health is seeking to hire a Chief Medical Officer of Special Needs Plans to develop, implement, support and promote strategies, policies and programs that drive delivery of holistic care for the Aetna Special Needs Plans population and MMP membership. This leader will manage the following business units: Utilization Management for MMP & FIDE plans and Care Management Physician support team for Duals, MMP & FIDE plans. In addition, this role will oversee innovative clinical program development, collaborate with departments that engage with this membership (i.e. CM, UM, G&A, etc) effectively collaborate with network leadership and ensure delivery of compliant, quality care for these members


The Chief Medical Officer role will report directly to the VP and Chief Medical Officer of Aetna Medicare with a matrix relationship to the VP of Medicare Duals Segment.


Responsibilities


• Leverage existing knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for this population and other complex health populations to optimize risk adjustment, clinical quality and care management.


• Provide thought leadership on design and delivery of care model for special needs populations across medical, behavioral and social service needs.


• Actively support compliance/audit functions to maintain standardized systems, policies, programs, procedures and workflows that ensure the health plan exceeds care management, regulatory and quality standards.


• Organization and oversight of Medical Directors, who provide utilization management review for MMP / FIDE populations and care management support for Duals, MMP and FIDE members. Effectively coach and support physician team to drive performance.


• Ensure Medical Directors are applying the medical / clinical resources, consistently to promote right service is provided at the right time for each member.


• Responsible for operational efficiencies and quality oversight work managed by the SNP Physician teams


• Develop and operationalize clinical strategy, including evaluation of new innovative solutions, evaluating clinical and financial opportunity and supporting implementation.


• Provide clinical acumen to a broad spectrum of programs that promote constituent-responsive care for SNP members.


Enhance effectiveness of interdisciplinary rounds to promote appropriate member utilization and improved member experience.


• Assesses medical trends and develops mitigating actions to improve performance.


• Chief Medical Officer is a critical clinical and business leader in both internal and external forums related to the SNP population:


• Internally, engaged with the SNP business team & Network leaders in shared responsibility for overall medical cost and quality results.


• Effectively communicate clinical state of SNP plans to Senior Management and staff at all levels.


• Externally, serves as a liaison to key stakeholders related to population health for SNP members.


• Contribute to achieving overall company goals of growth, financial performance including cost of care and clinical quality improvement


• Aid in achieve/ exceed applicable HEDIS, Stars, local state performance targets and goals for the SNP population.


• Shares responsibility with the Duals Business leadership in managing budget needs for the segment.


• Serve as clinical chair or member support for internal oversight around model of care, care management, credentialing, Quality, compliance and other essential internal committees.


This is a remote/ work from home position with expected 10% – 25% travel


Pay Range


The typical pay range for this role is:


Minimum: 221,000


Maximum: 476,000


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


• Must meet COVID-19 requirements


• 7+ years clinical practice experience


• 3+ years management in programs such as Duals, Medicaid, SNP, MMP or FIDE


• 5+ years progressive leadership and management experience in healthcare/ physician leadership


• 2+ years experience with Utilization Management and Care Management of complex populations such as Duals/MMP/FIDE


• Experience in managed care and value based programs


• Demonstrated commitment to diversity, equity and inclusion


• Demonstrated abilities in relationship building and collaboration


• Demonstrated abilities to create partnerships between departments / business areas


Preferred Qualifications


• 10+ years clinical practice experience


• 7+ years progressive leadership and management experience in healthcare/ physician leadership


• 5+ years experience with Duals, MMP, Utilization Management, Care Management


• 2+ years experience with programs managing Long Term Services & Support and/or Medicaid


• 5+ years experience driving diversity, equity and inclusion


• 5+ years experience driving relationship building and collaboration


• Demonstrated abilities to create partnerships between LOB, Medical Affairs, Utilization Management, Care Management


Education


• M.D. or D.O.


• Medical License – Valid license in at least 1 State


Business Overview


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.


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