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Chief Medical Officer Aetna Better Health of California

Company name
Aetna Inc.

Location
San Diego, CA

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CHIEF MEDICAL OFFICER

POSITION SUMMARY

Aetna Better Health of California is looking for a Chief Medical Officer (CMO) to lead our clinical team. The Senior Director Medical Health Services (CMO) for Medicaid in California 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/Medi-Cal 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. Candidates who have Medicare experience would be considered though Medicaid/Medi-Cal is highly preferred. Previous experience with Medicaid/Medi-Cal Long Term Care / MLTSS/ TANF / SPD /MCE and CHIP populations, and, pharmacy benefit management and behavioral health integration experience highly preferred. A thorough understanding and experience working in a delegated and non-delegated delivery model is highly preferred. Excellent Communication skills are a must. The CMO will act as the “Clinical Leader” for Aetna Better Health of California and must be willing to travel throughout the state on an “as needed” basis.

Relocation Assistance provided if necessary. The CMO will be located in the San Diego, CA office.

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.

Actively and credibly discusses complex care situations with clinicians and clarifies Aetna’s plan, contract and policy parameters in complex and non-standard medical situations.

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.

Conducts up-front analysis of policy, systems, and regulatory changes to manage impact and interdependencies.

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 development and implementation of 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.

Has responsibility for overall Utilization Management, Case and Disease Management for delegated and non-delegated members, establishing appropriate oversight of these functions.

Has responsibility for resolving member grievances and appeals related to clinical matters.

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 organizations that support Medicaid members.

Has responsibility to provide 24/7 access.

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 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.

Demonstrated ability to work in delegated and non-delegated models with focus on members getting timely and appropriate medical care.

Education:

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 California or ability to obtain medical license in California is a requirement for this position.

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.

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.

Employment Type

Regular

Career Band Description

Management

Company info

Aetna Inc.
Website : http://www.aetna.com

Company Profile
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees’ dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The company’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.

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