Aetna Medical Director (Value Based Contracting) in Pittsburgh, Pennsylvania

Req ID: 50186BR

POSITION SUMMARY

The Medical Director is both an internally and externally facing Medicare position that will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish a competitive business advantage for Aetna. The Medical Director will interface with external Medicare provider partners to drive enhanced population health and optimize overall provider performance on quality, utilization and cost metrics. The Medical Director will also participate in the development, implementation, and evaluation of clinical/medical programs.

Fundamental Components:

The VBC (Value Based Contracting) Medical Director will drive optimized performance and enhanced value by:

Forging strong relationships with external providers.

Establishing partnerships across the internal matrix with Network, internal clinicians and other subject matter experts.

Providing clinical expertise, leadership and guidance to the Medicare Provider Collaboration team.

Analyzing utilization and outcome data to identify gaps and actionable opportunities and communicating those opportunities with internal and external teams.

Participating in the development of action plans that promote population health, enhanced quality for members and overall performance improvement; and collaborating with local provider systems to influence care management programs.

Additional Responsibilities:

Analyze data and various reports for clinical meetings with external provider groups.

Help support and grow the RN Program Team.

Act as a Brand Ambassador and help drive performance.

Attend meetings with VBC partners in person and via Phone / WebEx or Skype.

Build strong relationships both internally and externally.

BACKGROUND/EXPERIENCE

2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Managed Care experience preferred. Board certification required, Family Medicine, Internal Medicine or Geriatrics preferred.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Board Certification in a recognized specialty including post-graduate direct patient care experience

Active and current state medical license without encumbrances

Medical/American Board of Family Practice is desired

Medical/American Board of Internal Medicine is desired

Medical/American Board of Internal Medicine & Geriatric Medicine is desired

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years

Functional - Leadership/Act as company spokesperson to external constituents/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User

REQUIRED SKILLS

Leadership/Collaborating for Results/FOUNDATION

DESIRED SKILLS

Leadership/Developing and Executing Strategy/ADVANCED

Telework Specifications:

Flexible telework / office-based schedule (must live near certain office location) Pittsburgh location ideal or ability to get to Pittsburgh. Northeastern Ohio can work as well with ability to get to Pittsburgh when needed.

ADDITIONAL JOB INFORMATION

This position will support the development and implementation of new care models supporting value based arrangements. 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 may benefit future generations. 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.

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