Aetna Medical Director (Big Sky Region) in Denver, Colorado
Req ID: 52005BR
The Medical Director for the Big Sky Region will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Occasional weekend work on a quarterly basis will be expected.
Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs.
Work at Home position once training is completed / Must be located in Utah, Colorado, Nevada, Montana or Wyoming.
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
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Previous experience in Managed Care specifically Medicare Preferred but not required.
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 required
Active and current state medical license without encumbrances required
Functional - Medical Management/Medical Management - Administration/Management/1-3 Years
Functional - Medical Management/Medical Management - Concurrent Review/1-3 Years
Functional - Medical Management/Medical Management - Physician Relations/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Clinical / Medical/General Management/1-3 Years
Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User
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
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
Benefits Management/Understanding Clinical Impacts/ADVANCED
General Business/Communicating for Impact/ADVANCED
UT / CO / NV / MT / WY
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.*EEO Statement Aetna is an Equal Opportunity, Affirmative Action Employer
Job Function: Health Care