Chief Medical Officer (Aetna Better Health of Ohio)Primary Location: New Albany, Ohio
Additional Locations: OH-New Albany Apply
The Chief Medical Officer for Aetna Better Health of Ohio 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 and Medicare Managed Care experience having worked with state regulators and CMS and executed on strategic initiatives and programs, including the Dual Eligible population and in Long Term Services and Supports (LTSS).
Strong leadership experience, strategic vision and a proven ability to execute on clinical initiatives are a “must have” in this position. Excellent Communication skills are a must.
The CMO for Aetna Better Health of Ohio 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 case management, utilization management, quality management, network management, and clinical coverage and policies.
Responsible for leadership of all clinical activities including proper provision of covered services to members; Case management activities, Behavioral health activities, UM activities, and developing clinical practice standards and clinical policies and procedures. Develops and implements medical management programs/policies.
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 and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
Expands 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 MyCare and potentially the Ohio Medicaid Managed Care program.
Works directly with all other medical officers 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.
Seeks out, introduces and applies innovative ideas to Aetna with input from customers and active involvement in industry, professional, academic and community participation.
3 to 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 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.
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
Active and current OH state medical license without encumbrances or ability to obtain medical license in OH is a job requirement for this position.
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 Ohio 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 MyCare and Ohio Medicaid members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Ohio, 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.
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.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
59004Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer
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