VP, Medicaid Chief Medical OfficerPrimary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix, CA-Los Angeles, CA-San Francisco, CO-Denver, FL-Miami, GA-Atlanta, IL-Chicago, MA-Boston, MN-Minneapolis, NY-New York, TN-Franklin, TX-Dallas Apply
•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.
MD Board Certification is required.
Location: Open to location; Phoenix AZ would be preferred. Potential Telework Position: Yes Percent of Travel Required: 25 - 50% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: 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.
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