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CVS Health Executive Director, Chief Duals Officer - Ohio in Ohio

Job Description

At CVS Health we are bringing our heart to every moment of your health.™ The Aetna Duals Segment is rapidly expanding and searching for a leader for one of our largest markets who shares our passion for actively listening to our customers, showing empathy, and delivering innovative solutions. The Chief Duals Officer – Ohio will be the local executive in charge of the Aetna Ohio My Care integrated Medicare-Medicaid Pan (MMP) as well as be accountable for the performance of Medicare Advantage Duals Special Needs Plans (DSNPs) in the Ohio/Kentucky market. The CDO will cultivate key stakeholder relationships including serving as the primary executive point person with the Ohio Department of Medicaid (ODM) for Aetna Duals programs. Driving growth and member experience as well as overseeing P&L are key aspects of the role. The CDO will collaborate with Medicare market leadership, Duals segment leadership and related corporate teams.Key responsibilities • Responsible for the overall financial performance of Dual plans within the Ohio/Kentucky market• Establishes and maintains a system for reviewing/assessing the state contract, for reporting regarding the contract, and for suggesting actions to improve services to the state agency • Coordinates with internal resources to implement State contract requirements and maintain compliance• Maintains primary relationship with representatives of the state and local regulatory agencies • Establish lobbyist relationships, attend meetings with State officials/Legislators, and maintain awareness of political and competitive landscape as well as regulatory impact to Dual plans• Develop and sustain safety net provider relations, provider relations, and community involvement• Collaborate within Duals segment to design and deliver supplemental benefits/value added services, including local relationships with delegated vendors • Partner with network, marketing, outreach and sales teams to drive growth strategies and execution• Contribute to segment strategic planning and development of annual operating plan for Duals market • Identify financial opportunities for revenue enhancement, membership growth, medical cost savings, quality improvement, and administrative cost efficiencies• Drive DSNP local product strategy and local market intelligence, be responsible for achieving target market position• Achieve market performance goals via local execution of STARs/quality withhold, compliance, and cost structure reduction (SAIs) initiatives in collaboration with Medicare market leadership, Duals segment leadership and related operational teams• Responsible for the plan performance related to all required Federal and State audits• Responsible for the management and organization of local Duals plan activities• Manages performance and establishes strategic direction and specific goals for staff

Required Qualifications

• Approximately 10 years progressive management experience in managed care or a health care related position, with demonstrated experience with all aspects of financial management within medical delivery and/or managed care systems. • Knowledge and experience of Medicare and Medicaid principles and State Regulator relationship management extremely valued and preferred. o MMP and DSNP expertise will be highly valued• Must have P&L expertise and possess a strong financial, bottom-line focus• Strong facilitative leadership and business problem solving skills • Effective technical skills regarding health plan administration, profit and loss accountability, medical management, business development, member engagement, quality outcomes, NCQA accreditation, contract compliance, provider satisfaction, value-based contracting, local marketing/community outreach and state government affairs.• Existing working relationships with Ohio Department of Medicaid (ODM) leadership will be valued• Prior working relationships with key stakeholders within local communities served by Aetna’s Dual products will be valued• Knowledge of current health care marketplace dynamics • Ability to build relationships with a diverse workforce and cross functional groups• Proven ability to work successfully within a matrix environment and influence internal stakeholders. • Must currently live in Ohio or willing to relocate to Ohio• Align with the Heart at Work Behaviors of CVS Health – Put people first; Join forces; Inspire Trust; Rise to the Challenge; Create Simplicity

Preferred Qualifications

See above

Education

Bachelor degree or equivalent

Business Overview

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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