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Position Summary: 

The Chief Medical Officer (CMO) provides oversight for medical policy implementation, and participates in the development, implementation, and evaluation of clinical/medical programs. 

The CMO shall devote a minimum of 32 hours per week to the OhioRISE Plan's operations to ensure clinical oversight and consultation and is a member of the OhioRISE Plan's executive team. 

Ohio residency required. This position will require time in the Ohio Office on a regular basis, with some travel required; 10-25% of the time; predominantly in-state with some use of a personal vehicle. 

Must have a valid and active Ohio drivers license, proof of vehicle insurance.

Fundamental Job Components:

• Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes. 

• Direct the utilization review process and oversee the quality of utilization determinations. 

• Ensure compliance with clinical goals through monitoring care management performance.

• Responsible for overall medical policies of the unit to ensure the appropriate and most cost-effective medical care is received, and for the day-to-day management of medical management staff.

• Responsible for recommending changes and enhancements to current managed care review guidelines and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols. 

• Develops, implements, and interprets medical policy including medical necessity criteria, clinical practice guidelines, and new technology assessments.

• Leads clinical staff in the coordination of quality care.

• Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.

• Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.

• Expands Aetna's medical management programs to address member needs across the continuum of care.

• Provides thought leadership for quality initiatives for the plan

Specific to the OhioRISE contract, responsibilities include but are not limited to:

• Ensuring that the OhioRISE Plan makes timely medical decisions, including after-hours consultation as needed.

• Leading all major clinical, population health management, and quality improvement components of the OhioRISE Plan.

• Developing, implementing, and interpreting medical policies and procedures, including service authorization, claims review, discharge planning, and medical reviews performed through the OhioRISE Plan's grievance and appeal system.

• Leading the administration of all medical management activities of the OhioRISE Plan.

• Serving as the chair or co-chair of the Utilization Management committee and of the OhioRISE Plan's internal quality improvement committee.

• Play a lead role in monitoring the overall safety of members with complex and or comorbid medical conditions.

• Coordinating with the MCOs' care management staff and providers on medical services not included in the OhioRISE Plan's service array, early and periodic screening, diagnostic and treatment (EPSDT), receipt of maternal and postpartum care, family planning, and preventative health strategies.

• Serving as a key clinical lead in developing and implementing evidence-based clinical policies and practices;

• Participating in regulatory/accreditation reviews. 

• Working with MCO's clinical leadership as needed for integration of all health care needs and services for OhioRISE Plan's members. 

• Assuming key role in quality improvement initiatives, care coordination activities, and member safety activities (i.e., incident management).

Required Qualifications: 

• At least 5 years’ experience in the health care delivery system e.g., clinical practice and health care industry. 

• At least five years of experience with children's behavioral health services. 

• Must be a physician with a current, unencumbered license through the Ohio State Medical Board and Board Certification in a recognized specialty including post-graduate direct patient care experience.

Education: 

MD or DO Required Board Certification required in an ABMS or AOA recognized specialty. 

Board Certification in Child & Adolescent Psychiatry preferred.

Physicians who are Board-certified in Pediatrics or Adolescent Medicine with significant Behavioral Health or Addiction Medicine experience/specialization will be considered.
 

Pay Range

The typical pay range for this role is:

$184,112.50 - $396,600.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 08/30/2024