Aetna Senior Medical Director (Aetna Community Care) in Houston, Texas

Req ID: 57317BR

POSITION SUMMARY

We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are. The Senior Medical Director is a member of the Aetna Community Care Management team. The SMD will participate in designing, developing and deploying the Aetna Community Care Model across markets and lines of business for the State of Texas. He/she will act as a subject matter expert to fellow team members in clinical design of the program. The SMD will develop and oversee member services under the model such as care team ICT reviews, peer to peer reviews of members care plans with community based practicing physicians, and overall quality reviews of all services under the model. The SMD will facilitate communication between members, physicians and administration.

Fundamental Components:

Contributes to business direction and strategic leadership in support of medical management programs.

Develops, implements, and promotes strategies, tactics, and programs that drive the delivery of quality healthcare in a cost effective manner.

Contributes to strategies, tactics and programs for care management, quality management, and community engagement for members, community Partners and providers.

Shares information on business operations, key trends, financial performance, and best practices with colleagues and customers.

Collaborates with other areas of Aetna to ensure the highest quality community care model is delivered to our members.

Ensures timely execution of all deliverables in accordance with due dates.

Assists in helping to develop new and innovative health related activities to meet the clinical mission, goals and philosophy of care for Aetna Community Care members, including digital paths.

Proactively evaluates and analyzes medical, pharmacy, behavioral health, and healthcare trend drivers and proposes clinical programs and/or improvements to effectively manage these trends for plan sponsors.

Represents Aetna Community Care at community activities and sales finalist meetings. Prepares and recommends appropriate use and design of medical plans.

Advises Aetna Community Care Leaders on health information technology system needs; develops, recommends, and conduct special studies of health needs and priorities through interpretation of clinical data for the State of Texas.

Advocates for the Aetna Community Care model and serves as liaison to professional societies as appropriate. Assists in the presentation of reports on medical management and quality initiatives to the Executive Leadership Team

BACKGROUND/EXPERIENCE desired:

Must have an active and current medical license without encumbrances Five (5) years of practice experience along with five (5) years of senior management experience in healthcare setting is preferred e.g. clinical practice/direct patient care; experience in case management, disease management, and quality management;

Managed Care/Medicare/government programs experience desired

Must be an M.D. or D.O. from an accredited university

Must have completed a residency training program in a recognized primary care or specialist (medical or surgical) specialty.

Board Certification in Internal Medicine, Family Practice, Emergency Medicine, or Pediatrics is preferred; will consider qualified applicants from other medical specialties.

Experience in Public Health a plus

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/General Management/1-3 Years

Functional - Medical Management/Medical Management - Case Management/1-3 Years

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years

Functional - Clinical / Medical/Disease management/1-3 Years

Functional - Quality Management/Quality Management/1-3 Years

TECHNOLOGY EXPERIENCES

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

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

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

Telework Specifications:

Part Time Telework at the discretion of the hiring manager

ADDITIONAL JOB INFORMATION

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 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.