AVP, Clinical Value and Innovation - Aetna

Requirements

• 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.
• Education/Other
• Medical Degree - Board Certification required.
• Pay Range
• The typical pay range for this role is:$227,630.00 - $490,280.00

Additional Information

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. 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. Medical Degree - Board Certification

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