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Behavioral Health Medical Director (IlliniCare - Aetna Medicaid)

Primary Location: Burr Ridge, IL
Additional Locations: IL-Burr Ridge
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Description:
Position Description:

IlliniCare (An Aetna owned Medicaid plan)is looking for a board-certified, Illinois-licensed psychiatrist with at least five years combined experience in mental health and substance use disorder services. This person will oversee and be responsible for all behavioral health activities in the health plan, including oversight of coordination activities with the Illinois Department of Health and Environment, and shall work closely with the behavioral health supports director and other medical officers to ensure the delivery of holistic and integrated person-centered care.

The Medical Director will be responsible for provider education regarding best clinical practices, pharmacy utilization, quality improvement and responsible health care expenditure to improve clinical outcomes. They will help lead continued improvement and evolution of the delivery system in the assigned market, including working collaboratively with providers to encourage development of new and more community-based types of care, and better integrating behavioral health, physical health, and social services.

This individual will also work across the national organization to support the Medical Management staff, ensuring timely and consistent responses to members and providers related to precertification and appeal requests. The medical director will 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.

Aetna operates Medicaid managed care plans in sixteen States: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia.

Fundamental Components: Will primarily support utilization management transactional reviews such as medical and pharmacy prior authorization, including weekend coverage when assigned, as well as appeals and quality of care case reviews.

Background / Experience: Minimum 3-5 years of clinical practice experience in the health care delivery field. Experience with managed care (Medicaid and Medicare preferred) utilization review.

Required Education: The highest level of education desired for candidates in this position is a MD or DO Certification

Licenses: Active and current state medical license without encumbrances is required. Multiple state licensure a plus.

Board Certification in a Aetna recognized specialty is 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. Together we will empower people to live healthier lives.

Required Skills:
General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices

Desired Skills:
General Business - Applying Reasoned Judgment

Functional Skills:
Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Clinical coverage and policies, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff, Medical Management - Medical Management - Quality Management

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

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by 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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