$250K — $500K+*
Allied Health Professionals, Medicine, Healthcare Management
11 – 15 years
This is an exciting time to join CVS Health, as well Aetna’s Health Care Business, as we collectively accelerate upon our strategy to enhance health care delivery for our members across our suite of clinical program offerings and capabilities. Within the Medicaid Care Management organization, we are supporting continued membership growth and are well positioned within the marketplace with a portfolio of strong products. We are seeking top leadership talent that brings their heart to work every day to join forces and create simplicity for our members.
The VP of Medicaid Care Management will support the organization led by the SVP of Clinical Services. This role is responsible for providing leadership and direction to a large team of clinical and non-clinical colleagues supporting over 2.7 million Medicaid members. Leads day to day operations and manages a large annual operating budget to design, deliver and enhance a suite of holistic clinical engagement programs including Integrated Care Management, LTSS, Foster Care, OH Rise Behavioral Health, field-based care management, population health programs, gaps in care communication and behavioral health programs.
• Development, implementation and oversight of people, processes and technology required to engage with Aetna’s Medicaid members using a population health approach to targeted member engagement. Responsible for clinical program outcomes, interventions, compliance and financial value.
• Responsible for Medicaid Care Management program development and monitoring of quality patient standards, patient and payor satisfaction levels and ensuring that patients are receiving prioritized, clinically appropriate and quality services.
• Scaling, strategic enhancement and day to day operations of the clinical operations including supporting significant growth in operations, clinical platform migration, compliance and operational enhancements to drive year over year cost efficiency improvements across 15+ state plans.
• Monitors care management activities to demonstrate prospective compliance with current federal, state and local contracts, standards, guidelines and regulations.
• Active thought leadership and partnership across the full clinical strategy and model of care for the Medicaid line of business, inclusive of CM and UM program design and driving innovation across the clinical functions to improve performance and member outcomes.
• Leads the integration of CVS assets for the benefit of Medicaid member experience, inclusive of a high degree of interaction with Aetna Behavioral Health, Health Hub, Minute Clinic, and serves as a thought leader in the expansion of our home health engagement in light of expanding enterprise capabilities.
• Collaboration with the Government Lines of Business and Medical Affairs organization, as well as across the growing CVS Health portfolio of assets, to transform the health care experience for CVS customers and Medicaid members.
10-15% travel expected
• 10-15 years leading large matrix clinical organizations
• 10+ years proven strategic relationship building in matrix organizations
• Strong knowledge Medicaid products, including contributing to RFPs.
• Proven success with transformational programs that improve outcomes.
• Experience leveraging Digital technology will be highly valued.
• Proven experience with financial budget planning
• Management Consulting services background will be valued.
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
• Registered Nurse (RN) or similar clinical background
• Bachelor’s Degree
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. 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.