Aetna Medical Director (Aetna One Advocacy) in New Albany, Ohio
Req ID: 50122BR
The Medical Director (MD) for Aetna One Advocacy is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical/business leader resource for external providers, plan sponsors, and regulatory agencies while working to achieve successful integration and effectiveness of the medical/care management programs. The Medical Director that fills this position will be a part of Aetna One Advocacy which is a high touch and extremely collaborative program.
We are currently looking for two (2) Medical Directors for this team.
Lead the clinical staff in the coordination of quality care on behalf of members.
Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities including precertification, concurrent review/discharge planning, case management, disease management and quality management.
Partner with medical management leadership to increase effectiveness of the care management program and promote the integration of other clinical support programs.
Provide clinical guidance in promoting member quality of care and reviewing/addressing potential lapses.
Proactively use data analysis and periodic assessments to identify opportunities for quality improvement.
Mentor employees and supports ongoing training and development of clinical staff.
Work collaboratively with other functional areas that interface with medical management including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals.
Act as critical medical leader for external providers, plan sponsors, regulatory & accrediting agencies, and community in general.
Act to engage providers and facilities in improving the quality of care delivered to our members and assure that our shared relationships are maintained and improved.
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. An understanding of utilization management, care/case management, precertification, managed care and benefit administration. Ability to work with teams of clinical and nonclinical staff to support care management.
The highest level of education desired for candidates in this position is a MD or DO.
LICENSES AND CERTIFICATIONS
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
Active and current state medical license without encumbrances
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Clinical / Medical/Precertification/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Functional - Clinical / Medical/Quality management/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Leadership/Collaborating for Results/FOUNDATION
General Business/Communicating for Impact/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Promoting Health Information Technology/ADVANCED
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 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