At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Aetna is seeking to hire a Head of Clinical Value and Innovation. This Medical Doctor role will function as the strategic thought partner to the VP of Clinical Value and Innovation - leading the end-to-end management of Aetna's clinical strategy and innovation around opportunities for medical cost savings, optimizing provider and vendor relationships, ensuring clinical quality and reliability, and driving cost efficiencies while focusing on providing high quality care to our members. This work will include producing and standing up care model creations based on member condition and care approach, Population Health solutions, vendor management solutions, provider and clinical quality innovative arrangements, as well as Federal/State/CMS regulation changes and ensuring compliance with our regulatory bodies.
Want more jobs like this?
Get Business Operations jobs in Hartford, CT delivered to your inbox every week.
- Develops and leads the clinical strategy to improve health outcomes and decrease medical cost.
- Responsible for selection, relationship management and monitoring performance of the Utilization Management, Care Management and Population Health. Ensure adherence to regulatory, accreditation, and compliance requirements.
- Collaborates with VP, Clinical Value and Innovation on deciding when to build capabilities vs outsourcing.
- Leads clinical cost of care mitigation and SWAT teams focused on clinical optimization and management and quality performance and establishing clear KPI metrics for effective execution.
- Develop new innovative provider clinical quality models to execute less administrative burden with shared metric optimization of health care quality, member experience, and cost. Focus should be on the entire suite of CVS abilities to operationally facilitate a better value experience to the providers and members.
- Develop innovative scoreable action items (SAI) from ideation through business case across all lines of business focused on population-based uniqueness of lines of business and needs.
- Partners with Clinical operations Network, service operations inclusive of line of business leads to develop mitigation strategies, identify opportunities for improvement, and initiate corrective action plans when needed.
- Provides clinical thought leadership expertise and facilitates executive presentations to customer including regulatory agencies (i.e. CMS).
- Aligns others around the purpose to gain support and commitment.
- Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
Qualifications
The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company's business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:
- 15+ years' experience of Managed Care experience with an emphasis on clinical management.
- Strong understanding of managing conditions from end to end.
- Experience executing business models with external partners (hospitals, large provider groups).
- Experience with cost of care contractually, clinically, and operationally.
- Experience with quality oversight with vendors, hospitals, and large provider groups
- Experience developing thoughtful, innovative clinical strategies that optimize the achievement of business objectives and drives the delivery of quality healthcare.
- Strong leadership capabilities and a bias towards operational execution.
- Exposure to federal, state, and regulatory agencies.
- Collaborative mind- set
- Easily adapts to change and encourages continuous challenge of the status quo
- Strong business and financial acumen.
- Demonstrate executive presence and ability to interact with internal and external constituents.
- Operational expertise in creating business models and analyzing data.
Medical Degree - Board Certification required.
Pay Range
The typical pay range for this role is:$227,630.00 - $490,280.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.