Aetna Medical Director (Telecommute from within - WY, UT, CO, MT, NV) 37058BR in Provo, Utah
Req ID: 37058BR
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.
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
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.
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 - 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
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
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Shaping the Healthcare System/ADVANCED
Leadership/Collaborating for Results/FOUNDATION
Benefits Management/Supporting Medical Practice/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
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.
Job Function: Health Care