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Aetna Clinical Solutions Medical Director in Allentown, Pennsylvania

Req ID: 56266BR

POSITION SUMMARY

Operating with a balance of internal and external-facing activities that support a shift to a higher-touch, patient-centric focus, the Clinical Solutions Medical Director will develop, implement, support, and promote population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare to establish a sustainable competitive business advantage for Aetna. These strategies, policies, and programs are comprised of care management, utilization management, quality improvement, network management as well as clinical coverage protocol. The Medical Director will be provider and patient facing and have fluency in data analytics.

Work At Home Position - Pennsylvania

Fundamental Components:

Specialized Care Planning: Influence the design, development and deploying Care Models across markets and lines of business. Act as a subject matter expert to fellow team members in clinical design of Care Model programs and ability to shape specialized care planning strategies for medically complex patients to improve care outcomes. Collaborate with local provider systems and influence care management programs.

Analytics Oriented Care: Develop and oversee member services under the model such as care team IDT reviews, peer to peer reviews of members care plans with community-based practicing physicians, and overall quality reviews of all services under the model. Ability to assess analytics on utilization data, outcome data, identifying gaps in care.

Proactive virtual and physical engagement: Facilitate communication between care teams, members, physicians and administration; participate in marketing, sales, evaluation of member/customer utilization outcomes and participating physician staff performance.

End to End Market Understanding: Represent Care Models at community activities and sales finalist meetings. Externally facing brand ambassadors; inform and influence all constituents (e.g. providers, broker/consultants, employers, state and federal government regulators). Advises Care Model Leaders on health information technology system needs; develops, recommends, and conduct special studies of health needs and priorities through interpretation of clinical data. Support the clinical strategy plan for product opportunities. Assists in the presentation of reports on medical management and quality initiatives to the Executive Leadership Team.

Participate in Sales presentation meetings providing the value proposition story behind the partnerships.

Collaborating with the Medical Management staff both internally and externally ensuring timely and consistent responses to members and providers.

Using data analytics to inform and influence population health to drive behavior change and expand Aetna's medical management programs to address specific member conditions across the continuum of care.

Provide UM (Utilization Management) services based on business demands and shifting business needs.

BACKGROUND/EXPERIENCE:

3 to 4 years of experience in Health Care Delivery System

Understanding of Value Based Contracting/Accountable Care and how this relates to improving the quality of care for our members through collaboration.

Passion and ability to influence and drive better outcomes in healthcare delivery.

Demonstrated experience in population health management and managed care

EDUCATION

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

LICENSES AND CERTIFICATIONS

Active unrestricted state medical license

Medical/Medical License - Pennsylvania is desired

Board Certified in Aetna recognized specialty

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Concurrent Review/1-3 Years

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

Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years

TECHNOLOGY EXPERIENCES

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

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

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

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

ADDITIONAL JOB INFORMATION

Exceptional oral and written communication skills.

Demonstrated leadership qualities that inspire and develop others.

Commitment to coaching and collaborating.

Demonstrated transformation/change management skills and experience.

Demonstrated comfort with rapidly changing technology for engagement and analytics

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.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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