Addiction Medicine

2 weeks ago


Columbus, Ohio, United States CVS Health Full time

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.



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


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.



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