Aetna Medical Director (Spinal Subject Matter Expert) in Albany, New York
Req ID: 51293BR
The Medical Director is responsible for providing clinical expertise, oversight for medical policy implementation and business direction in support of the development, implementation, and evaluation of clinical/medical programs to promote the delivery of high quality, constituent responsive medical care. The Medical Director is a critical medical and business leader and contact for external providers, plan sponsors, and regulatory agencies and participates in the strategic medical management of local markets.
There are two (2) open positions available one focused on West Coast and one of the East Coast. Work at Home Position. The Medical Director will be considered a Spinal Subject Matter Expert.
In this role you will:
-Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities in the execution of precertification, concurrent review/discharge planning, appeals, case management, disease management, and quality management
-Partner with medical management leadership to increase effectiveness of medical management programs and to promote the integration of other Aetna medical programs
-Participate in quality management activities at regional and market levels including those necessary to achieve NCQA and URAC accreditation
-Proactively uses data analysis to identify opportunities for quality improvement and to positively influence the cost effective delivery of quality care
-Work collaboratively with other functional areas that interface with medical management including provider relations, contracting, member services, sales, benefits and claims management, healthcare delivery, national medical services and national accounts to achieve the business goals of the company
3-5 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Active and current state medical license without encumbrances is required M.D. or D.O. required Board Certification in a recognized specialty is required
The highest level of education desired for candidates in this position is a MD or DO.
LICENSES AND CERTIFICATIONS
Medical Management/ABMS/AOA - Neurological Surgery is desired
Medical Management/ABMS/AOA - Orthopedic Surgery is desired
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Clinical / Medical/General Management/1-3 Years
Functional - Medical Management/Medical Management - Administration/Management/1-3 Years
Functional - Medical Management/Medical Management - Physician Relations/4-6 Years
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
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Leadership/Collaborating for Results/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
Service/Providing Solutions to Constituent Needs/ADVANCED
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.
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