Lead Director, SNP Clinical Strategy & Innovation

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As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Develop, enhance, and refine clinical strategy for Aetna’s Medicare SNP Plans. Support Duals clinical and administrative operations including Model of Care filing for Special Needs Plans including D-SNPs, C-SNPs, I-SNPs. This position is focused on strategic alignment of clinical initiatives and identifying opportunities to enhance capabilities to manage clinically and socially complex dual eligible and special needs populations.  The resource will serve as clinical liaison focused on monitoring the effectiveness and impact of clinical programs and facilitating development and implementation of program enhancements, new initiatives, and facilitating external partnerships. 

Fundamental Components/Job Description:       

To be successful in this position, the candidate must have demonstrated experience with Model of Care or other similar regulatory filings (Program Description, RFP development, Quality Program Review, etc.), designing and implementing clinical and related operational programs for dual eligible and/or clinically complex Medicare populations, and partnering across a matrixed organization to translate specialized clinical initiatives into achievable goals.

·       Lead strategic integration and ongoing enhancement of clinical programs and initiatives for SNP members including approaches to mediate impacts of social determinants of health.

·       Serve as liaison + leader supporting the advancement of clinical programs and services to support SNP performance and enhance overall capabilities to manage complex populations

·       Oversee the collection, analysis and submission of Model of Care and associated regulatory reports to ensure full compliance with accreditation and laws

·       Facilitate cross functional planning efforts to formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction to support achievement

·       Serve as subject matter expert and business resource for Model of Care requirements, associated clinical model, and clinical reporting requirements

·       Develop and participate in presentations and consultations to internal and external audiences

·       Update and maintain trainings related to Model of Care

Required Qualifications

·       10+ years experience with significant leadership roles

·       Experience with Model of Care development and filing processes or other similar regulatory filings (Program Description, RFP development, Quality Program Review, etc.)

- Experience with both Medicare and Medicaid clinical programs and services

·       Experience designing and implementing clinical and related operational programs for dual eligible and clinically complex Medicare populations and for understanding Medicare utilization management, Special Needs Plan model of care and care management requirements, and other specialized clinical initiatives 

·       Ability to synthesize program performance and clinical outcomes

·       Demonstrated experience successfully implementing change in complex organizations

·       Demonstrated superior business process, project management and organizational redesign experience

Preferred Qualifications

• MBA
• Registered Nurse (Master’s preferred)