Aetna Medical Director (Behavioral Health) 45954BR in Phoenix, Arizona

Req ID: 45954BR

POSITION SUMMARY

The Medical Director (Behavioral Health) will provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues. Will provide leadership for medical policy implementation and utilization management services. The Medical Director will participate in the development, implementation, and evaluation of clinical/medical programs. Participate on a team of psychiatry colleagues in medical management of high risk members. Monday through Friday hours and shared on call. Utilization review and accreditation (NCQA, AAHCC/URAC) experience preferred. - MD from accredited (ACME) American or Canadian medical school or equivalent training in a foreign medical school with successful completion of ECFMG and FLEX exams. Full training in a ACGME approved U.S. or Canadian residency program. - Current active license without encumbrances to practice medicine in the state of Arizona. - Board certification by the American Board of Psychiatry and Neurology.

Fundamental Components:

Provide medical leadership, oversight and consultation for Utilization Management staff during coverage hours.

Conduct peer to peer case reviews for medical necessity determination and benefit authorization.

Ensure compliance with clinical goals through monitoring care management performance.

Ensure adherence to standards of quality of care in case reviews and report concerns to the CMO as appropriate.

Develop, implement and interpret medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments.

Communicate medical necessity determinations to providers, including grievance and appeal rights for the member for adverse determinations.

Participate in special projects as assigned.

BACKGROUND/EXPERIENCE

  • 5-8 years experience involving substantial direct patient care at multiple levels of care.

  • Managed care experience, as provider and manager of care.

  • Familiarity with current research and use of psychopharmacologic and psychotherapeutic modalities of treatment.

  • Current active license without encumbrances to practice medicine in the state of Arizona.

    EDUCATION

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

    LICENSES AND CERTIFICATIONS

    Medical/American Board of Psychiatry and Neurology is required

    Medical/Medical License (MD) or (DO is required

    FUNCTIONAL EXPERIENCES

    Functional - Medical Management/Medical Management - Quality Management/1-3 Years

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

    REQUIRED SKILLS

    Benefits Management/Interacting with Medical Professionals/ADVANCED

    Benefits Management/Maximizing Healthcare Quality/ADVANCED

    Benefits Management/Understanding Clinical Impacts/ADVANCED

    Telework Specifications:

    Option for telework will be evaluated after a certain period of employment

    Flexible telework / office-based schedule (must live near certain office location)

    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.

    Please note that this position is not eligible for benefits

    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.

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Job Function: Health Care