Aetna Behavioral Health Medical Director (KS MCD) in Overland Park, Kansas
Req ID: 51948BR
The Behavioral Health Medical Officer/Medical Director (BH-MD) is dedicated to the KanCare CONTRACT. This position oversees and be responsible for all Behavioral Health activities, including oversight of coordination activities with KDADS and shall work closely with the Behavioral Health Supports Director and other Medical Officers to ensure the delivery of holistic and integrated person-centered care. This position develops, implements, supports, and promotes Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs.
Expands Aetna's BH medical management programs to address member needs across the continuum of care.
Supports the BH Medical Management staff ensuring timely and consistent responses to members and providers.
Oversees BH utilization review/quality assurance, directing case management.
Provides clinical BH expertise and business direction in support of medical management programs that integrate physical and behavioral health and the social determinants of health through participation in clinical team activities.
Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
Minimum of 5 years combined experience in mental health and SUD services.
Education and Certification Requirements:
M.D or DO Board Certification Psychiatrist specialty including post-graduate direct patient care experience with any of the following:
Preferred Addictionologist: ASAM Certification
Preferred: Addiction Psychiatry Sub Specialty Certification
Required: State Approved Addictions Experience
Active and current Kansas state medical license without encumbrances
The highest level of education desired for candidates in this position is a MD or DO
LICENSES AND CERTIFICATIONS
Medical/Medical License (MD) or DO is required
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Supporting Medical Practice/ADVANCED
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Benefits Management/Understanding Clinical Impacts/ADVANCED
Leadership/Fostering a Global Perspective/ADVANCED
Benefits Management/Maximizing Healthcare Quality/ADVANCED
ADDITIONAL JOB INFORMATION
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Kansas is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of KanCare members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Kansas, and we will support you all the way.
Computer literate; proficiency with MS Office Suite Applications(WORD, Excel, Outlook, etc.) and keyboard navigation skills required.
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.