CVS Health
Location
Woonsocket, RI | United States
Job description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
CVS Health is seeking to hire a Chief Medical Officer to develop, implement, support, and promote strategies, policies and programs that drive the delivery of holistic care for the Aetna Medicare population.
A pioneer in the Medicare industry, Aetna has served Medicare beneficiaries since 1966, when it paid the nation’s first Medicare claim. Aetna now serves nearly 11 million ( Medicare members nationwide, including 3.4 million ( currently enrolled in an Aetna Medicare Advantage plan.
This leader will manage the following business units:, Population Health Provider Collaboration, Group MA Customer Support, and Risk Adjustment Support. The leader will also co-manage medical and care management of Medicare Advantage beneficiaries.
The successful candidate will partner with the Medicare business and Clinical Services organization to set strategic direction for initiatives that impact clinical results and the member experience. Contribute towards improvement of clinical outcomes and Stars performance by collaborating with enterprise partners, providers, select vendors, and group plan sponsors.
This leader is responsible for providing clinical acumen to a broad spectrum of programs that promote constituent-responsive care for Medicare members. This role assesses medical trends and develops mitigating actions to improve performance. The CMO is a critical clinical and business leader in both internal and external forums related to Medicare. Internally, this leader engages with clinical teams in shared responsibility for overall medical cost and quality results for the Medicare population. Externally, this leader is a liaison to key stakeholders related to clinical and population health in the Medicare arena.
Major Responsibilities:
Sets strategic direction, policies and standards for initiatives that drive clinical results for the Medicare population. Evaluates clinical programs and assesses member outcomes to ensure optimal quality and a differentiated member experience
Provides clinical guidance in operating effective medical programs to promote member quality of care and in reviewing potential lapses in the quality of care. Targets opportunities for better management through coordination with other departments or resources that interface with clinical services
Adapts clinical programs to be appropriately focused for a Medicare population
Serves as a clinical subject matter expert representing Medicare population for existing and proposed clinical programs, ensuring efforts drive clinical, Stars, risk adjustment and provider performance
Uses medical evidence and data analysis to improve the identification, prioritization and management of quality cost-effective care for Medicare members
Develops and maintains external relationships to fuel innovation of population health programs that address social determents of care, social isolation, and virtual based care. Collaborates with CVS Transformation team to create new programs that optimize enterprise assets and differentiates the care experience for Medicare members
Acts as the lead business and clinical liaison to network providers in support of Medicare programs and value-based care
Applies medical cost discipline to clinical initiatives implemented for Medicare population. Works collaboratively to design, validate and improve organizational dashboards that support advanced utilization, cost analysis and cost driver identification/management
Participates in quality management activities at national, regional and market levels including those necessary to achieve NCQA and URAC accreditation, Star measures and CCIP/QIP programs
Partners with cross-functional clinical and operational leaders to achieve enterprise strategic goals
The typical pay range for this role is: Minimum: $350,000.00 Maximum: $425,000.00 Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Education:
Medical Degree required
Board Certification required. Internist or Geriatrician will be valued.
Experience & Qualifications:
Strong knowledge of Medicare, complex health care delivery environment, value based care, population health, social determinants of health.
Board Certification required. Internist or Geriatrician will be valued.
Proven experience setting strategic direction and development of policies and standards that drive clinical results and a differentiated member experience; applying medical evidence and data analysis to improve care for Medicare members; development of innovative population health programs that address social determinants for care, social isolation and virtual based care
Proven ability to work in a large, highly matrixed organization with strong relationship management skills
Excellent presentation and communication skills
Sense of urgency and ability to drive results in an appropriate and compliant manner
Strong people management skills
Ability to think strategically and develop and execute a vision that delivers results
Ability to work Hybrid Model (in office Tuesday / Wednesday / Thursday)
Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
Align with the values of CVS Health – Innovation, Collaboration, Caring, Integrity, Accountability
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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