Aetna Medical Director (KS MCD LTSS Clinical Officer MD) in Overland Park, Kansas
Req ID: 51947BR
The LTSS Clinical Officer/Medical Director (LTSS CO/MD) directs health care services for FE or individuals of any age with physical, intellectual and/or developmental disabilities. The LTSS CO/MD oversees and is responsible for all primary and physical and Behavioral Health services provided to individuals receiving LTSS, and to comparable populations enrolled in KanCare, and all clinical activities pertaining to the operation of LTSS programs and services, including Preventive Care and the management and coordination of Chronic Conditions and physical health needs, and the integration and coordination of primary and other physical health services for Members receiving LTSS.
The LTSS CO/MD is also responsible for working with the CMO, Behavioral Health CMO (BH-CMO), Pharmacy Director and the Behavior Supports Director to ensure the integration of Physical and Behavioral Health services and supports and LTSS, as applicable, for individuals in each of these populations and to oversee the quality improvement initiatives regarding behavior supports and the appropriate use of psychotropic medications in each of these populations.
Expands Aetna's medical management programs to address member needs across the continuum of care
Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
Oversees utilization review/quality assurance, directing case management
Provides clinical expertise and business direction in support of medical management programs 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 of experience in directing Health Care Delivery System e.g., Clinical Practice and Health Care Industry for FE or individuals of any age with physical, intellectual and/or developmental disabilities.
Behavioral Health experience.
Education and Certification Requirements:
M.D., Board Certification in Geriatrics specialty including post-graduate direct patient care 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
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.
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