Aetna Senior Medical Director (Medicare) in Blue Bell, Pennsylvania

Req ID: 56787BR


This Senior Medical Director will lead the clinical aspects of Medical Risk Analysis. Position is posted for NY but will accept other geographical areas.

Fundamental Components:

Serves as clinical lead on initiatives to ensure accurate documentation of chronic conditions and leverage clinical information to improve health care quality and outcomes. Work is highly collaborative and involves participating on teams within the Medicare Segment and across the Enterprise. Position is responsible to identify opportunities, drive execution and monitor performance to achieve desired outcomes.

Specific areas of work include:

· Developing and implementing approaches to leverage clinical information to improve health care quality and outcomes. For example, collaborating with teams to integrate clinical information into algorithms that identify members for care management and making actionable clinical information available to provider partners (e.g., physicians, nurse practitioners, etc.)

· Optimizing the In-Home Assessment (IHA) Program in which clinicians complete an annual comprehensive assessment with members in their homes to improve clinical and Stars performance

· Optimizing all processes aimed at accurately and thoroughly documenting chronic conditions and submitting information to CMS.

· Developing educational materials and educating providers on how to accurately and thoroughly document chronic conditions.

· Participating in audits initiated by external bodies related to the documentation of chronic conditions

· Responding to information requests from Medicare market business and clinical leaders pertaining to the aforementioned bodies of work

· Providing clinical expertise and business direction in support of creating or enhancing additional medical management programs as requested


3-5 years experience in the health care delivery system e.g., clinical practice and health care industry.

Medical Risk Analysis background preferred.

Board Certified in Aetna recognized specialty.

Active unrestricted medical license required.


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

Telework Specifications:

Full-Time WAH; office based could be an option; not limited to NY/NY


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 candidate'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.