The position reports directly to the Vice President of Commercial Care Management.
The Head of JV Clinical Transformation provides strategic leadership for the development of provider centric clinical assessments and performance improvement strategies, road map, tools, and methodologies.
S/he leads the East and West teams of clinicians and business leaders and is responsible for maintaining a highly productive and motivating work environment to achieve business goals and deliver superior solutions for transforming Joint Venture partners across Medicare Advantage and Commercial Lines of Business.
S/he develops population health strategy and implements performance improvement capabilities designed to enable Strategic, Business and Clinical Transformation within provider organizations to help achieve the triple aim. Leads the implementation of solutions with provider organizations and provides work stream oversight across multiple teams.
The Senior Medical Director also provides leadership in the development and implementation of transformation plans to achieve targeted improvement goals.
S/he collaborates with other leaders within Aetna, the transformation team and across CVS Health to identify enabling technology and service products, clinical programs, and approaches that integrate informatics and performance improvement for population health strategies.
Key Responsibilities Include:
• Assesses providers' capability infrastructure for population health management (pre-deal and concurrent reviews).
• Develops, prepares, and presents JV clinical performance to Sr. leadership.
• Accountable for managing the providers' financial risk of ~ $250M for each region.
• Interacts, presents, and engages with C-suite level JV and provider partners throughout the transformation journey.
• Designs, develops, and oversees implementation of a comprehensive customized strategy and roadmap to drive a successful population health management capabilities and operational approaches for each of the Joint Venture provider partners.
• Captures and elevates the feedback from the market place and the provider community to Sr. Leadership that will shape the clinical strategies going forward. (continuous process improvement).
• Supports the JV teams and provider partners through the implementation of the recommendations.
• Provides consultation and advisory support to the JV and Health System CMO's internal staff and provider to close identified capability gaps.
• Monitors and tracks clinical performance against the defined targets and engage with providers in deep dive projects for process improvement and review of technology enablement.
• Leads a team of Directors, Clinical Strategist, and Business Transformation Consultants.
• Partners with Enterprise clinical team to implement ad deploy various skills and transformation projects applicable to the JVs.
• Manages projects, people, customer expectations, and business priorities to achieve constituent satisfaction.
• Oversees day-to-day activities and builds a strong team through formal training, diverse assignments, coaching, mentoring and other development techniques.
• Challenges the status quo and drives transformation activity that will realign current health care processes.
• Understands and probes into technical details; mentors others to do the same.
• Contributes to a motivated work environment by working effectively to achieve common goals.
• Drives the overall design or methodology of tactical and strategic advisory solutions that satisfy needs across products, segments, and clients to increase engagement.
• Communicates and consults with Senior Leadership to ensure that informatics and performance improvement strategies focus on long term results and represent all constituencies effectively.
• Manages budgets, plans, and expenses for large scale strategic projects, and participates in cost center management.
• Develops a collaborative relationship with provider partner and JV leadership; provides clinical expertise and consulting/advisory support
• Collaborates with the external provider partner and internal leaders and stakeholders to design, implement, and continually improve outcomes tracking and measurement models related to Provider Transformation.
• Collaborates with business partners to provide advice on clinical strategy that drive metrics, tools, and outcomes models for development and evaluation of projects and programs.
• Proactively builds and maintains internal and external key relationships.
• Oversees identification and tracking of proof points for the JVs to be used in the sales process.
• Develops and implements data sharing strategies that enable appropriate and timely interventions.
• Working with JV CMOs, establishes annual savings targets that are forward priced into the product.
• Evolves JV clinical models to meet the needs of a dynamic market.
• Develops, tests and scales new use cases for integrated clinical and claims data.
• Participates in Sales presentation meetings to provide the value proposition story behind the partnerships
• Passion and ability to influence and drive better outcomes in healthcare delivery.
• Demonstrated transformation/change management skills and experience.
• 8-10 years demonstrated experience in population health programs & analysis methods and tools, health economics, research design, predictive modeling, and clinical program development.
• Ability to collaborate with and understand the needs of C-level executives and help translate those needs into an actionable plan.
• Demonstrated ability to communicate technical concepts and implications to business and policy decision-makers and clients.
• Exceptional oral and written communication skills, including formal presentations for all levels of management combined with strong collaboration/influencing abilities.
• Minimum 12 years managerial and project management experience required.
• 5-10 years in both payer and provider settings highly preferred.
• Strategic business acumen and proven organizational, management, and leadership skills that inspire and develop others.
• Demonstrated collaborative style, with ability to influence leadership and diverse teams and build strong relationships.
• Demonstrated strategic thinking, problem solving and critical thinking abilities.
• Demonstrated success leading direct, indirect, and virtual teams in a matrixed environment with successful direct report leadership and coaching experience.
• Demonstrated ability to negotiate complex and opposing points of view, reach consensus, and work collaboratively to achieve key goals.
• Financial acumen and experience with VBC financial models.
• Experienced working with clinical and claims data.
• Successful experience working with clinicians, finance, and operational leaders to drive performance improvement.
• Travel required based on Business Needs - Will utilize Webex / Microsoft Teams technology for meetings when applicable
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
- If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
- If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
Previous Experience in Managed care with a Health Plan
Previous experience supporting Joint Ventures between Health Plans and Health systems
MD or DO or RN or BSN
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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