Aetna Senior Medical Director - (Telecommute) 40831BR in Raleigh, North Carolina

Req ID: 40831BR

POSITION SUMMARY:

This is a professional clinical sales role supporting existing clients and new business for ActiveHealth Management

FUNDAMENTAL COMPONENTS:

Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes. Direct the utilization review process and oversee the quality of utilization determinations. Ensure compliance with clinical goals through monitoring care management performance Responsible for overall medical policies of the unit to ensure the appropriate and most cost effective medical care is received, and for the day-to-day management of medical management staff Responsible for recommending changes and enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols. Develops, implements, and interprets medical policy including medical necessity criteria, clinical practice guidelines, and new technology assessments Leads clinical staff in the coordination of quality care 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 Responsibility for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise Expands Aetna's medical management programs to address member needs across the continuum of care

BACKGROUND/EXPERIENCE desired:

10-15 years experience in the health care delivery system e.g., clinical practice and health care industry. M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience. Active and current state medical license without encumbrances. Experience directly supporting sales/client management

EDUCATION

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

LICENSES AND CERTIFICATIONS

Medical/MD License is desired

REQUIRED SKILLS

General Business/Demonstrating Business and Industry Acumen/MASTERY Sales/Selling Products and Services/MASTERY

TELEWORK SPECIFICATIONS:

Nationwide Work from Home

ADDITIONAL JOB INFORMATION:

M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience. Active and current state medical license without encumbrances.

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.

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Job Function: Health Care