Senior Medical Director, Aetna Better Health of Illinois

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Position Summary:

The ABHIL Chief Psychiatrist (Senior Medical Director) will serve as a strategic and operational partner to the State, CEO, COO, Health Service Officer, and other executive team members in managing all Behavioral Health activities by driving clinical excellence, achieving measurable health outcomes, and supporting quality and medical management in a highly matrixed environment. The ABHIL Chief Psychiatrist will also support national strategic processes and priorities as well as conceptualization, design, and implementation of strategic priorities for Behavioral Health in the IL HealthChoice Medicaid program.  The ABHIL Chief Psychiatrist will be responsible for cost containment outcomes and defined KPI’s and overall growth and success of the plan through effective clinical leadership in support of behavioral health across all populations.

Accountable for overall plan results and the delivery of high-quality cost-effective products and services that strategically align to the goals of the State partner. Ensures members get the right health care treatment for their needs, working to eliminate low value care, over and underutilization of health care services in alignment with the Quintuple AIM. Participates with plan leaders in identification and developing the appropriate enterprise and local strategies to fulfill plan business goals and growth imperatives. Provide clinical expertise to shape the integrative model of physical, behavioral, health related resource needs to support holistic care and optimal health outcomes.

Primary Job Duties & Responsibilities:

Responsibilities specific to Behavioral Health activities across all health plan populations.

Develop, implement, support, and promote state clinical programs, population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare to establish a sustainable competitive business advantage by supporting the plan goals.

Review, interpret and analyze data and trends at State level in: UM, CM, Pop Health, LTSS and Health Equity in order to identify risks and opportunities for improvement.

Serve as clinical executive leader for State regulators, providers, and other key partners.  Serve as clinical leader for provider engagement and enablement. Have oversight of the design, development, and deployment of Care Models and review medical care provided to Enrollees and medical aspects of the Provider Contract.

Ensure clinical programs are compliant with all national and state regulations including ensuring compliance with State and local reporting laws on communicable diseases, Child Abuse, and neglect Oversight of the Quality Assessment and Performance Improvement Program (QAPI)

Fundamental Components & Physical Requirements:

The ABHIL Chief Psychiatrist is a member of the plan executive leadership team and must collaborate cross functionally to achieve plan goals specific to the Behavioral Health program including:

Leads clinical strategy across all HFS pillars and HealthChoice Illinois populations. Develops and continuously updates an overall transformation strategy and set of key tactics for remediating those gaps, including critical success factors, metrics, and targets.

Provide direction, support and medical expertise and oversight to all areas within the clinical services including Care Management, Utilization Management, Population Health, Health Equity and Quality programs supporting state pillars for Behavioral Health aligned with the state contract.

Develops and continuously updates an overall transformation strategy and set of key tactics for remediating those gaps, including critical success factors, metrics, and targets.

Collaborating with the Medical Management stakeholders both internally (UM/CM, Pharmacy, Quality, network, compliance, LTSS, VBS team) and externally (Agency, regulators, providers, community partners, and JOC’s ensuring timely and consistent responses to the needs of members and providers.

Building and inspiring a culture of continuous improvement for better quality of care measured by improving CAHPS/HEDIS/STARS outcomes and supporting appropriate utilization of services.

Work closely with Quality, Healt