Skip to main content

A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Medical Director

Primary Location: Arlington, TX
Additional Locations: TX-Arlington, TX-Austin, TX-Dallas, TX-El Paso, TX-Fort Worth, TX-Houston, TX-Irving, TX-San Antonio, TX-Sugar Land
Apply
Description:
Operating with a balance of internal and external-facing activities that support a shift to a higher-touch, patient-centric focus, the Medical Director will develop, implement, support, and promote population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare to establish a sustainable competitive business advantage for Aetna. These strategies, policies, and programs are comprised of care management, utilization management, quality improvement, network management as well as clinical coverage protocol. The Medical Director will be provider facing and have fluency in data analytics.

Fundamental Components:
Ability to collaborate with all stakeholders, understanding the guidelines/basics (how to access) the requirements, opportunities to shape within the scope in the role as a Health plan medical director. Analytics-Oriented Care: Ability to analyze data (e.g., medical cost trends) and articulate trend and solutions. Ability to manage complex cases and client relationships with plan sponsors. Proactive Virtual and Physician Engagement: Leveraging multi-channel platforms and digital technology to interface with internal and external customers in virtual and physical settings. End to End Market Understanding: Strong business acumen. Understands and proficient articulating products, financial impacts and market demands. Consultant and supplier of actionable information. Expertise in market/state DOL regulations delivering HEDIS/STARS consultation. Communications: Both oral and written skills and comfort in presenting to varied groups. Building and fostering relationships and partnering with the external community and providers in a pro-active approach to population health. Using data analytics to inform and influence population health to drive behavior change and expand Aetna's medical management programs to address specific member conditions across the continuum of care. Collaborating with the Medical Management staff both internally and externally ensuring timely and consistent responses to members and providers. Providing clinical expertise and business direction in support of medical management programs through active collaboration and participation in clinical team activities. Acting as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Attend & engage in Sales presentation meetings providing the value prop/story behind the partnerships Executing predetermination reviews, reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Manage UM transactional work(front line reviews and appeals). Building and inspiring a culture of continuous improvement for better quality of care. Creating products that utilize patient engagement in a new and effective manner utilizing tools and analytics. Overseeing utilization review/quality assurance directing case management. Provide UM services based on business demands and shifting business needs.

Background Experience:
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 encumbrances M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen

Functional Skills:
Clinical / Medical - Concurrent review / discharge planning

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Education:
Medical - Medical License (for all states)

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 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.

Click To Review Our Benefits (PDF)

Apply

Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

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.