Description: POSITION SUMMARYAetna Better Health of Kentucky (an Aetna Medicaid Plan) is looking for a Medical Director to 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 Fundamental Components:Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs. 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. BACKGROUND/EXPERIENCE 2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. EDUCATIONThe highest level of education desired for candidates in this position is a MD or DO. LICENSES AND CERTIFICATIONSActive unrestricted state medical license requiredBoard Certification in Aetna recognized specialty required FUNCTIONAL EXPERIENCESFunctional - Medical Management/Medical Management - Case Management/1-3 YearsFunctional - Medical Management/Medical Management - Disease management/1-3 Years REQUIRED SKILLSLeadership/Collaborating for Results/FOUNDATIONGeneral Business/Communicating for Impact/ADVANCED DESIRED SKILLSGeneral Business/Turning Data into Information/ADVANCEDGeneral Business/Demonstrating Business and Industry Acumen/ADVANCED ADDITIONAL JOB INFORMATIONAetna 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. 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 candidates'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. 59742 Required Skills: Leadership - Collaborating for Results, Leadership - Fostering a Global Perspective, Service - Working Across Boundaries Desired Skills: General Business - Applying Reasoned Judgment, General Business - Maximizing Work Practices, Leadership - Collaborating for Results Potential Telework Position: Yes Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: 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 Be sure to include your preferences below so you won ??t miss out on openings in your preferred job category and location. At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna. Join Our Talent Community Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company (Aetna) and its affiliates.
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