Aetna Chief Medical Officer (Aetna Better Health of Illinois) in Miami, Florida
Req ID: 48174BR
Aetna Better Health of Illinois is looking for a Chief Medical Officer (CMO) to lead our clinical team. The Senior Director Medical Health Services (CMO) for Medicaid in Illinois is responsible for leadership of strategic medical management activities 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 and acts as a key business partner in network development, product design, strategic planning and sales support.This is a new role for Aetna Better Health of Illinois that will serve a dual function. First, the candidate will act as the Chief Medical Officer of the IL "Duals Eligible" (Medicaid / Medicare) plan. Secondly, the candidate will serve in an oversight and support function as a "Regional CMO" supporting the Michigan and Ohio plans when assistance is necessary. Specialty in Geriatrics and / or experience with Duals Eligible Medicare / Medicaid population highly desired.
Relocation Assistance provided if necessary. The CMO must be located in the Chicago area or willing to relocate.
Fundamental Components:Provides clinical and business leadership in support of strategic business objectives. Responsible for leadership of medical management activities that meet the strategic needs of business segments and plan sponsors. Participates in evaluation of product design; impact on quality, care and service. Participates in short and long range program planning, total quality management and external relationships. Responsible for the design and implementation of medical policies, goals and objectives. Provides professional leadership and direction to the functions within the medical management department. Responsible for the development of budgets, staffing plans, assuring the adequate allocation of resources. Monitors member and provider satisfaction survey results and implement changes. Participates in the development of strategic planning for existing and expanding business. Uses data analysis to identify opportunities for quality improvement and to positively influence practice patterns, plan sponsor trends or benefit plan designs. Develops and improves tools to support Aetna's medical management programs. Expands Aetna's medical management programs to address member needs across the continuum of care. Ensures rigorous, consistent and disciplined design and execution of medical management programs. Partners with other medical management functional organizations to ensure consistency and standardization of policy and procedures. Develops, manages and builds teamwork among a diverse group of medical management professionals.
Promotes quality and medical appropriateness of care. Has responsibility for multiple medical management initiatives and achievement of desired performance. Leads quality management activities at regional and market levels including those necessary to achieve NCQA and URAC accreditation. Works collaboratively with other functional areas that interface with medical management including provider relations, member services, sales, benefits and claims management, health care delivery, national medical services and national accounts. Oversees triage and referral for behavioral health staff in respective regions/units (Behavioral Health Medical Director).Acts as critical medical leader for external providers and plan sponsors, including regulatory & accrediting agencies, and community in general.
Background / Experience:
3 - 5+ years of experience in the health care delivery system, e.g. clinical and health care industry required with 3 - 5 years of additional leadership and management experience in the health care industry.
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.
The highest level of education desired for candidates in this position is a MD or DO.
Licenses and Certifications:M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.Active and current state medical license without encumbrances in the State of Illinois or ability to obtain medical license in Illinois a requirement for this position. Michigan or Ohio License desired as well.
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.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Health Care