Aetna Medical Director (Telecommute from within - WY, UT, CO, MT, NV) 37058BR in Billings, Montana

Req ID: 37058BR

POSITION SUMMARY

The position is for Medical Director in the Big Sky Region of the North Mountain Territory within Network & Clinical Services and will report to the Senior Medical Director. The role will support the multi-client care management program and clinical product lines in the company as assigned and support provider engagement initiatives that drive high quality cost effective care.

Fundamental Components:

Key roles and responsibilities include:

Expands Aetna's Clinical Services programs to address member needs across the continuum of care including medical management determinations

Supports the Clinical Services staff ensuring timely and consistent responses to members and providers.

Oversees utilization review/quality assurance and provides direction to case management

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

Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise

BACKGROUND/EXPERIENCE desired:

5+ years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.

Board certification required. Must have an active license in Utah; if hired, must acquire a NV license.

Primary care specialty (IM, FP, Emergency) preferred; master of public health, business administration or health administration desired.

EDUCATION

The highest level of education desired for candidates in this position is a MD.

LICENSES AND CERTIFICATIONS

Medical Management/ is desired

Managed Care/ is desired

Quality Assurance/ is desired

Healthcare Management/ is desired

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Clinical coverage and policies/1-3 Years

Functional - Quality Assurance/Quality Assurance Certified Tester/

Functional - Medical Management/Medical Management - Physician Relations/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

Technical - Aetna Applications//1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Shaping the Healthcare System/ADVANCED

Leadership/Collaborating for Results/FOUNDATION

DESIRED SKILLS

Benefits Management/Supporting Medical Practice/ADVANCED

Leadership/Developing and Executing Strategy/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

Telework Specifications:

Medical Director position is based in the Big Sky (CO, UT, MT, NV and WY) market. Flexible telework / office-based schedule (must live near certain office location) is needed for this position.

ADDITIONAL JOB INFORMATION

This is an exciting opportunity to join a growing market and to be part of a team focused on improving health and health care for Aetna members within the Big Sky region. Experience and interest in integrated care delivery by engaged network providers is essential with a goal towards improved communication, coordinated care and optimizing health. Knowledge of medical management, medical benefits, integrated care delivery, value-based payment and population health management is desired.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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Job Function: Health Care