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Chief Medical Officer

Oklahoma City, OK, USA | CVS Health

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    General Management
    Biotech/R&D/Science
  • Experience:
    3-5 years
Job Description:
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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.


**This is a remote based (work from home) role. Candidate must reside in Oklahoma**


Aetna Better Health (ABH) is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna® Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members.


Position Summary:


The Chief Medical Officer (CMO) provides leadership of medical management activities. Develops and implements medical management programs/policies. Responsible for clinical activities including proper provision of covered services to members, UM activities, and developing clinical practice standards. Must reside in Oklahoma. Some travel may be required in-state to meet business needs.


Fundamental Components:


• Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes.

• Direct the utilization review process and oversee the quality of utilization determinations.

• Ensure compliance with clinical goals through monitoring care management performance.

• Responsible for overall medical policies of the unit to ensure the appropriate and most cost-effective medical care is received, and for the day-to-day management of medical management staff.

• Responsible for recommending changes and enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols.

• Develops, implements, and interprets medical policy including medical necessity criteria, clinical practice guidelines, and new technology assessments.

• Leads clinical staff in the coordination of quality care.

• Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.

• Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.

• Responsibility for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

• Expands Aetna’s medical management programs to address member needs across the continuum of care.

• Acts as a champion supporting continuous quality improvement efforts to improve the care and services delivered to all populations covered under the contract.

• Works directly with other medical officers and department/business unit leads to promote excellence in care and service delivery.


Pay Range


The typical pay range for this role is:

Minimum: 178,750

Maximum: 385,000


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


• Resides in Oklahoma.

• 3 or more years’ experience in the health care delivery system e.g., clinical practice and health care industry.

• Active and current Oklahoma state medical license without encumbrances.

• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.

• Ability to travel in-state; travel to the office anticipated and based on business needs.


Preferred Qualifications


• Medicaid and managed care experience.


Education


M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.


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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