Aetna Medical Director (Behavioral Health) in Louisville, Kentucky
Req ID: 63037BR
Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs.
We are currently seeking a Behavioral Health Medical Director for Aetna Medicaid in our Louisville, KY location. The successful candidate will be responsible for providing clinical expertise and business direction in support of the medical management programs, including clinical review, case and quality management.
The Medical Director will act as a liaison to external customers and regulatory agencies.
Kentucky Location Highly Preferred but will consider potential for work at home as well.
Summary: Aetna Medicaid has a model of care: To collaborate with the people we serve to integrate physical and psycho social wraparound services based on a bio-psycho social understanding of our member s lives.
• Be committed to the Medicaid/under served population, and to the principle that helping Medicaid members improve their health will drive lower costs and produce a return on investment for state Medicaid programs.
• Be committed to promoting recovery and enhancing resiliency for all members.
• Be comfortable working with data in collaboration with subject matter experts.
• Provide clinical expertise and business direction in support of medical management programs through participation with clinical teams in activities of pre-certification, concurrent review/discharge planning, case management, disease management, quality management and clinical claim review.
• Provide clinical guidance in operating effective medical management programs.
• Oversee triage and referral for behavioral health staff.
• Participate in quality management activities, including committee and accreditation needs.
• Lead clinical staff in assuring members care is coordinated in a fashion that achieves the most value for the available benefit.
• Act as a clinical liaison to state agencies and external provider community in general.
• Be comfortable in working in a fast-paced, fluid, high-energy environment where all team members are accountable for creating high quality work products, where cross-functional teamwork is routine, and where rapid-cycle development is required to meet market demands.
• M.D. or D.O, certified by American Board of Psychiatry and Neurology
• Active medical license without encumbrances in the Commonwealth of Kentucky
• Post-graduate direct patient contact of 5 years duration
• Experience working with individuals with serious/severe mental illness, disabling substance use disorders, or developmental disabilities, etc.
• Knowledge of NCQA/HEDIS and managed care behavioral health care standards and requirements.
• 4 – 6 years Clinical / Medical/Direct patient care (hospital, private practice).
• 1 – 3 years Medical Management/Medical Management - Managed Care/Insurance Administration. Preferred
• Medical Management/ABMS/AOA - Psychiatry is desired.
• Benefits Management, Wellness and Prevention experience preferred.
• Prior managed care experience preferred.
• Excellent leadership, development, and interpersonal skills.
• Effective and skilled public speaker and exceptional presentation skills.
• Ability to successfully operate in a highly matrixed and changing environment.
Additional Job Information:
Opportunity to join a growing managed Medicaid plan in a newly created position. 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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
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.