Aetna Senior Clinical Solutions Medical Director (Group Medicare) in New York, New York

Req ID: 56038BR

POSITION SUMMARY

As the Senior Clinical Solutions Medical Director you will be responsible for leadership of strategic medical management activities which contribute to the performance of the markets and promotes quality of care for our members. These responsibilities include development and implementation of medical programs/policies, enhancing relationships with providers and facilities, plan sponsor and regulatory agencies and acts as a key business partner in network development, product design, strategic planning and sales support.

Fundamental Components:

Use your experience with Medicare business; Behavioral Health experience is a plus.

Maintain an appropriate and effective organizational structure to support the business strategy & achieve desired outcomes.

Provide input to network management for regional market network creation, contracting, fees, & all other related activities necessary to drive optimal results.

Patient Management organization, including the development, implementation & execution of PM strategy Collaborate with National Medical Policy & National Quality Management Organizations as requested to ensure PM execution is aligned with overall health policy, quality standards & strategy.

Share responsibility for Regional market compliance & public relations.

Develop & maintain relationships with local & state medical associations as well as hospital & physician organizations.

Show significant managed care leadership experience with demonstrated results leading broad scope initiatives & change.

Show substantial & demonstrated track record of management & leadership success over a range of healthcare delivery programs & operations .

Candidates will have held market accountabilities for impacting & enhancing healthcare delivery, as well as for the associated financial & operating performance metrics on behalf of an organization.

Demonstrate a comprehensive knowledge of the healthcare market, and be conversant with diverse functional disciplines from both a strategic & tactical perspective.

Understand key competitive market dynamics and guide and oversee competitive trends analysis, cognizant of the market-specific issues which exist in the delivery of healthcare programs.

BACKGROUND/EXPERIENCE DESIRED

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

Previous experience in Population Health / specifically focusing on Medicare Population.

Previous experience designing programs and analyzing data to make strategic decisions.

Strong Interpersonal & Communication skills.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Board Certified in Aetna Recognized Specialty (ABMS or AOA)

Active State License without encumbrances

FUNCTIONAL EXPERIENCES

Functional - Medical Management//4-6 Years

Functional - Leadership//1-3 Years

Functional - Clinical / Medical//1-3 Years

Functional - Sales & Service//1-3 Years

REQUIRED SKILLS

Leadership/Driving a Culture of Compliance

Benefits Management/Encouraging Wellness and Prevention

Benefits Management/Interacting with Medical Professionals

DESIRED SKILLS

Benefits Management/Supporting Medical Practice

Benefits Management/Shaping the Healthcare System

Benefits Management/Understanding Clinical Impacts

Telework Specifications:

Full-Time Telework (WAH), Considered only for locations in a specific region, state, or city; training period in the office may be required, NY/NJ location preferred.

ADDITIONAL JOB INFORMATION

This Senior Clinical Solutions Medical Director will provide the opportunity to lead and influence a large Group Medicare population in partnership with the Senior leaders of this Group.

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.