Aetna Medical Director in New York, New York
Req ID: 60752BR
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.
The Medical Director will be considered a Spinal Subject Matter Expert.
Fundamental Components included but are not limited to:
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
Qualifications Requirements and Preferences:
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
Medical - Board Certified, Neurology, Medical - Certified American Board Of Surgery, Medical - Medical License (for all states)
Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - General Management, Medical Management - Medical Management - Administration/Management, Medical Management - Medical Management - Physician Relations
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance
Benefits Management - Interacting with Medical Professionals, Service - Improving Constituent-Focused Processes
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Health Care
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.