Medical Director (Aetna Better Health of West Virginia) WV MCDPrimary Location: Charleston, WV
Additional Locations: WV-Charleston, WV-Morgantown Apply
Aetna Better Health of West Virginia (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 West Virginia 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 West Virginia, and we will support you all the way.
Potential Work at Home when needed after initial training / combination of office based and work from home will be considered.
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 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.
64918Additional Job Information: Sound clinical knowledge and recognized as a credible clinical resource. General knowledge of the health benefits business, clinical issues, trends and medical management, medical care delivery systems, utilization management, quality management, contracting, benefits interpretation, provider relations and customer service. Interpersonal and listening skills that bring out the best in medical management staff. Ability to build a high performing team by promoting a culture of energy and commitment, mentoring employees and supporting ongoing training and development of staff. Ability to successfully operate in a highly matrixed and changing environment. Effective and skilled public speaker and presenter. Ability to implement complex program and monitor implementation and modifications. Ability to manage multiple priorities and deadline in an expedient and decisive manner. Computer literate; proficiency with MS Office Suite Applications(WORD, Excel, Outlook, etc.) and keyboard navigation skills required.
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of West Virginia 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 members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Heath of West Virginia, and we will support you all the way. Required Skills: Benefits Management - Interacting with Medical Professionals, Benefits Management - Supporting Medical Practice, General Business - Demonstrating Business and Industry Acumen Desired Skills: Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts, Leadership - Fostering a Global Perspective Functional Skills: Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - FE Clinical coverage & policies, Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Clinical claim review, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff Technology Experience: Aetna Application - QNXT, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, 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.
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