Aetna VP, Medicaid Chief Medical Officer in Phoenix, Arizona
Req ID: 60448BR
Aetna's Medicaid Chief Medical Officer (CMO) plays a strategic lead role, with a balance of internal and external-facing activities that support a shift to a higher-touch, patient-centric focus. In collaboration with various Medicaid leaders in personalized health, health care quality and equity and across all the State Medicaid health plans, the Medicaid CMO will develop, implement, support, and promote population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare to establish a sustainable competitive business advantage for Aetna Medicaid. These strategies, policies, and programs are comprised of care management, utilization management, quality improvement, network management as well as clinical coverage protocol.
Fundamental Components included but are not limited to:
• The Medicaid CMO will develop a clear and compelling vision and strategy and ensure enterprise strategies are aligned with emerging customer and market needs. S/He will identify critical goals and success factors for the Medicaid business and help guide the Aetna Medicaid clinical strategy in order to improve health at a lower cost. S/He has a proven ability to leverage understanding of the emerging health care environment to create the platform for change and to meet demands for evolving health management solutions.
• The Medicaid CMO oversees Medicaid medical management and clinical strategy for all health plans owned and administered by Aetna Medicaid. Works with Medicaid teams and Enterprise partners to support profitable growth of health plan markets and build strategies to support the needs of members on their health journey.
• Responsible for Aetna Medicaid medical policies that ensure the appropriate and most cost- effective medical care is received and responsible to lead the 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.
• Uses expertise in Case Management and Disease Management to collaborate with all stakeholders both at the shared services and State health plan levels, understanding the guidelines/basics (how to access), the requirements, opportunities to shape the scope of the Medical roles within Aetna Medicaid. Have oversight of the design, development and deployment of Care Models across all Aetna Medicaid and products. Acts as a subject matter expert to fellow team members in clinical design of Care Model programs and ability to shape specialized care planning strategies for medically complex patients to improve care outcomes.
• Ability to analyze data (e.g., medical cost trends) and articulate trend and solutions to internal and external stakeholders. Ability to consult with Aetna Medicaid Medical staff 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.
• Have an end-to-end Aetna Medicaid Market Understanding with strong business acumen. Understands and is proficient articulating products, financial impacts and market demands. Consultant and supplier of actionable information. Expertise in market/state DOL regulations delivering HEDIS/STARS consultation. Thought leader and is an externally facing brand ambassador; inform and influence all constituents (e.g. providers, broker/consultants, employers, state and federal government regulators). Collaborate with and provide strategic clinical direction to Care Management, Utilization Management, Network and Provider Relations to support the effective execution of medical services programs by the clinical teams that are provider and member facing.
• Builds and fosters the relationships and partners with the external community, enterprise CMO and segments to engage providers in a pro-active approach to population health. Using data analytics to inform and influence population health to drive behavior change and expand Aetna Medicaid s medical management programs to address specific member conditions across the continuum of care
• The Medicaid CMO has a constant focus across the enterprise on what will achieve the best result for the entire company rather than just their own unit or function. Is adept at negotiation and conflict resolution, demonstrating the ability to influence others, win support on critical issues, and reach consensus when appropriate.
Qualifications Requirements and Preferences:
Background in Medicaid is highly desired.
MD Board Certification is required.
Location: Open to location; Phoenix AZ would be preferred.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Management
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.