Medical Director (Aetna Better Health of Louisiana)Primary Location: Baton Rouge, LA
Additional Locations: LA-Baton Rouge, LA-Kenner Apply
Aetna Better Health of Louisiana (Aetna Medicaid Plan)is looking for a Medical Director to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs.
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Louisiana is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicaid members. Our vision incorporates community-based health care that works. We value diversity.
Align your career goals with Aetna Better Health of Louisiana and we will support you all the way.
In this role you will:
Reinforce clinical philosophy, programs, policies and procedures.
Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established criteria.
Provide medical review and support for case management and care coordination staff to ensure optimal care is rendered to our members according to the terms of the benefit members receive.
Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Assess Developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams.
Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
Be responsible for maintaining compliance with policies and procedures and implements them at the employee level.
Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Previous managed care experience with an insurer / payer highly preferred but not required
The highest level of education desired for candidates in this position is an MD or DO.
License and Certifications:
M.D. or D.O., Board Certification in a Aetna recognized specialty including post-graduate direct patient care experience.
Active and current state medical license without encumbrances
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.
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 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.
65340Required Skills: Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts Desired 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, Clinical / Medical - Precertification, Medical Management - Medical Management - Administration/Management, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Medical - Board Certified, American Board Of Family Practice, Medical - Board Certified, Internal Medicine, Medical - Board Certified, Pediatrics 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.
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