Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Aetna is seeking to hire a Head of Clinical Vendor Management. This clinician will lead the end-to-end management of Aetna’s clinical vendor arrangements to mitigate cost, optimize relationships, ensure quality and reliability, and drive cost efficiency while providing high quality care to members.

Key Responsibilities:

• Develops and leads the clinical strategy to improve health outcomes and decrease medical cost for vendor arrangements.

• Responsible for selection, relationship management and monitoring performance of the Utilization Management, Care Management and Population Health vendors. Ensure vendors adhere to regulatory, accreditation, and compliance requirements.

• Collaborates with VP, Clinical Strategy Operations on deciding when to build capabilities vs outsourcing.

• Leads clinical cost of care mitigation and SWAT teams focused on clinical vendor management, including establishment of governance processes. This includes creation and management of dashboards to measure quality performance and hold accountable to established metrics.

• Consult with vendors throughout the contracting process to determine model alignment and capabilities.

• Assist with scoreable action items (SAI) from ideation through implementation and maintenance across all lines of business.

• Partners with account, provider & vendor quality oversight teams to develop mitigation strategies, identify opportunities for improvement, and initiate corrective action plans when needed.

• Provides clinical expertise and facilitates executive presentations to customer including regulatory agencies (CMS).

• Aligns others around the purpose to gain support and commitment.

QUALIFICATIONS

• 15+ years’ experience of Managed Care experience with an emphasis on clinical vendor 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 vendors 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 executionExposure 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

• Hybrid or Remote working East Coast hours

EDUCATION/CERTIFICATION

Medical Doctor - Board Certification

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.

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 10/18/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.