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Aetna Chief Medical Officer Aetna Better Health of Kentucky in Louisville, Kentucky

Req ID: 67564BR

Job Description

POSITION SUMMARY:

The Sr. Clinical Solutions MD (CMO) for Medicaid in Kentucky is responsible for leadership of strategic medical management activities and processes which contribute to the performance of the markets and promotes quality of care for our members. These responsibilities include development and implementation of medical programs/policies, enhancing relationships with providers and facilities, plan sponsors and regulatory agencies.

The CMO acts as a key business partner in network development, product design, strategic planning, regulatory compliance and community outreach.

The ideal candidate will have previous Medicaid Managed Care experience having worked with state regulators and executed on strategic initiatives and programs. Strong leadership experience, strategic vision and a proven ability to execute on clinical initiatives are a “must have in this position.

The CMO will act as the “Clinical Leader for Aetna Better Health of Kentucky and must be willing to travel throughout the state on an “as needed basis.

The CMO for Aetna Better Health of Kentucky will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna.

Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management, and clinical coverage and policies.

FUNDAMENTAL COMPONENTS:

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

Is competent in data analysis and uses this to drive medical management strategy

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

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 Monitors medical policy including medical necessity criteria, clinical practice guidelines, and new technology assessments.

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.

Expands Recommends changes to Aetna's medical management programs to address members 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 Kentucky Medicaid.

Works directly with all other medical officers (both national and local) and department and business unit leads to promote excellence in care and service delivery.

Attracts, retains, measures, coaches and develops the talent to meet Aetna's current/future organizational goals.

Establishes and maintains strong and collaborative community and state governmental relationships.

Fosters an inclusive, engaged, success-oriented and accountable culture and working environment. Identifies talented individuals and works towards establishing pathways and training opportunities to accomplish this goal.

Seeks out, introduces and applies innovative ideas to Aetna with input from customers and active involvement in industry, professional, academic and community participation.

BACKGROUND/EXPERIENCE:

Three (3) to Five (5) + years of experience in the health care delivery system, e.g. clinical and health care industry required WITH an additional Three (3) to (5) years of additional leadership and management experience managed care.

Demonstrated ability to create business strategy to drive competitive advantage and shift direction as market conditions dictate.

Demonstrated ability to interact successfully with external providers.

LICENSES / CERTIFICATIONS:

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

Active and current KY state medical license without encumbrances or ability to obtain medical license in KY is a job requirement for this position.

EDUCATION:

The highest level of education desired for candidates in this position is a MD or DO

ADDITIONAL JOB INFORMATION:

Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Kentucky is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of our Kentucky Medicaid members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Kentucky and we will support you all the way.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Additional Job Information:

Demonstrated comfort with rapidly changing technology for engagement and analytics.Demonstrated transformation/change management skills and experience.Demonstrated leadership qualities that inspire and develop others.Commitment to coaching and collaborating.Exceptional oral and written communication skills.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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