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Aetna Aetna One Advocate Medical Director - SW in Franklin, Tennessee

Req ID: 66046BR

Job Description

The Medical Director (MD) for Aetna One Advocacy is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical/business leader resource for external providers, plan sponsors, and regulatory agencies while working to achieve successful integration and effectiveness of the medical/care management programs. The Medical Director that fills this position will be a part of Aetna One Advocacy which is a high touch and extremely collaborative program.

In addition to the front line medical director component of this role, 10% of this MD's time will be spent externally facing to assist in the continued growth of our business.

This position is based in High Point, NC with potential for work at home after initial training completed. Will be required to travel to office as needed for meetings and other training sessions.

Fundamental Components included but are not limited to:

-Lead the clinical staff in the coordination of quality care on behalf of members.

-Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities including precertification, concurrent review/discharge planning, case management, disease management and quality management.

-Partner with medical management leadership to increase effectiveness of the care management program and promote the integration of other clinical support programs.

-Provide clinical guidance in promoting member quality of care and reviewing/addressing potential lapses.

-Proactively use data analysis and periodic assessments to identify opportunities for quality improvement.

-Mentor employees and supports ongoing training and development of clinical staff.

-Work collaboratively with other functional areas that interface with medical management including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals.

-Act as critical medical leader for external providers, plan sponsors, regulatory & accrediting agencies, and community in general.

-Act to engage providers and facilities in improving the quality of care delivered to our members and assure that our shared relationships are maintained and improved.

-Act as a clinical representative in the external space. Presentation skills and interest is imperative in order to assist the sales team in securing additional business.

Qualifications Requirements and Preferences:

2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Active and current state medical license without encumbrancesM.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.


Medical - Board Certified, National Board Of Medical Examiners

Functional Skills:

Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - Disease management

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint

Required Skills:

Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, General Business - Communicating for Impact, Sales - Knowing Customers

Desired Skills:

Benefits Management - Shaping the Healthcare System, General Business - Turning Data into Information

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.