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Medicare DSNP Senior Medical Director

Primary Location: Beaver, Pennsylvania
Additional Locations: CT-Hartford, DE-Wimington, FL-Miami, IL-Chicago, MI-Detroit, NJ-Parsippany, NY-New York, OH-Columbus, PA-Beaver, VA-Richmond
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POSITION SUMMARY
We are expanding our Medicare Dual Eligible Special Needs Plan (DSNP) programs across the Aetna enterprise and are seeking a Senior Medical Director (SMD) who enjoys working in an interdisciplinary care team approach to help our most vulnerable members attain their health and wellness goals.

Fundamental Components:
The Aetna DSNP program is a member centric, team-delivered, care management model that joins members where they are in their healthcare journey. The Senior Medical Director is the leader of the DSNP Interdisciplinary Care Team (ICT). The SMD will participate in designing, developing and deploying the DSNP Model of Care across markets. He/she will act as a subject matter expert to fellow team members in clinical design of the program. The SMD will develop and oversee member services under the model such as care team ICT reviews, peer to peer reviews of members care plans with community based practicing physicians, and overall quality reviews of all services under the model. The SMD will facilitate communication between members, physicians and administration. The SMD will also interact and liaison between the DSNP program and market leadership and other departments within the enterprise. The SMD will work with the Learning and Performance Team to develop and present clinical training for care management team.

BACKGROUND/EXPERIENCE desired:
Must be an M.D. or D.O. from an accredited university Must have completed a residency training program in a recognized primary care or medical specialty. Board Certification in Internal Medicine, Family Practice, or Emergency Medicine is preferred; will consider qualified applicants from other medical specialties. Must have an active and current medical license without encumbrances. Must have Five (5) years of clinical practice experience and (3) years of senior management experience in healthcare setting e.g. clinical practice/direct patient care. Experience with care management programs/multidisciplinary care teams is preferred. At least 1 year of Managed Care experience is required. Medicare/Medicaid/government programs experience is preferred. Previous experience with a DSNP is a plus. Must enjoy working with/mentoring/educating nurses, social workers, pharmacists, care coordinators and other members of the ICT. Experience in Public Health a plus Mastery of benefits management/maximizing healthcare quality Advanced benefits management/understanding of clinical impacts Mastery of leadership and developing/executing strategy Advanced in benefits management/promoting health information technology a plus Advanced in benefits management/shaping the healthcare system a plus.

EDUCATION
The highest level of education desired for candidates in this position is a MD.

LICENSES AND CERTIFICATIONS
Medical/MD License is desired


FUNCTIONAL EXPERIENCES
Functional - Medical Management/Medical Management - Direct patient care/4-6 Years
Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years
Functional - Medical Management/Medical Management - Administration/Management/1-3 Years


Telework Specifications:
Position is national. SMD will not need to reside in any particular state. If the candidate happens to live near an office location, then the position will be Flexible telework / office-based schedule. If the candidate is not near an office, then fulltime WAH with travel to specific markets.

ADDITIONAL JOB INFORMATION
The SMD is an integral part of the SNP Interdisciplinary Care Team and provides clinical oversight and education the care management team as they assist some of Aetna's most vulnerable members. The SMD performs case reviews with the team and peer-to-peer discussions with physicians and other community providers as needed to understand and advance a member's care plan. The SMD works collaborates with the SNP Director on plan operations; development and implementation of policies and procedures; and developing operational metrics, and protocols. The SMD works with other members of the SNP Leadership Team in the evaluation of the Model of Care and its effectiveness and helps develop clinical programs to address changing needs of the SNP membership. The SMD represents the SNP program in a variety of internal and external meetings/events such as meetings with market leadership, network providers, community based agencies, sales/brokers, quality management, and pharmacy.

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.

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