, Connecticut

Job Description
Position Summary:The Medical Director (MD) for National Accounts 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 and business leader and contact for external providers, plan sponsor, and regulatory agencies and participates in the strategic medical management for our plan sponsors. The Medical Director will partner with medical management to increase effectiveness of medical management programs and promote integration of other Aetna medical programs.This position supports our Commercial Self Insured Plans and provides Medical Management to those Plans. Position can be located anywhere in country California / Oregon / Washington State or Central United States "Preferred".Fundamental Components:Execute predetermination reviews, reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Manage UM transactional work (front line reviews and appeals).Build and inspire a culture of continuous improvement for better quality of care.Oversee utilization review/quality assurance advising case management. Provide UM services based on business demands and shifting business needsPartner with medical management leadership to increase effectiveness of medical management programs and to promote the integration of other Aetna medical programs. Provide clinical guidance in operating effective medical programs to promote member quality of care and in reviewing potential lapses in the quality of care. Proactively use data analysis to find opportunities for quality improvement, to positively influence the effective delivery of quality care.Work collaboratively with other functional areas that collaborate with medical management within the National Account Care Management Solutions Team including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals of the company.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 assures that our shared business relationships are maintained and improved.

Required Qualifications
Background / Experience:Two + (2) years of proven experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.One to Two (1-2 ) years of experience in Clinical leadership (ex. quality review, peer review, group/practice management, hospital teams)One to Two (1-2 ) years of knowledge / experience in managed care (consultant, medical director, discharge planning)Education:The highest level of education desired for candidates in this position is a MD or DOLicenses and certifications:Medical/Medical License (MD) or (DO) is requiredAn Active Unrestricted State Medical License is required. Active Board Certification in an Aetna recognized specialty is required. Telework specifications:Considered for any US location; training period in the office may be required.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. 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.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.

Preferred Qualifications
Please review required qualifications above

Education
MD

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

, Connecticut

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