Aetna Chief Medical Officer (Aetna Better Health of Florida) in Sunrise, Florida
Req ID: 48232BR
Aetna Better Health of Florida is looking for a Chief Medical Officer (CMO) to lead our clinical team. The Senior Director Medical Health Services (CMO) for Medicaid in Florida 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 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 is highly preferred. Previous experience with Medicaid Long Term Care / TANF / and CHIP population highly preferred. Excellent Communication skills are a must. The CMO will act as the “Clinical Leader for Aetna Better Health of Florida 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 Sunrise, FL 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. 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.
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.
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 Florida or ability to obtain medical license in Florida is a requirement for this position.
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.
Job Function: Health Care
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.