LTSS Medical Director (Aetna Better Health of KS)Primary Location: Overland Park, KS
Additional Locations: KS-Overland Park, KS-Topeka, KS-Wichita Apply
The LTSS CO/MD is also responsible for working with the CMO, behavioral health medical director, pharmacy director, and behavioral supports director to ensure integration of physical and behavioral health services and supports and LTSS, as applicable, for individuals in each of these populations, and to oversee quality improvement initiatives regarding behavioral supports and the appropriate use of psychotropic medications in these individuals.
- Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established evidence-based criteria
- Conduct daily hospital admission and complex discharge rounds
- Direct LTSS population activities, including evaluating the need for these services and ensuring collaboration among providers
- Conduct peer to peer discussions
- Perform high dollar deep dive reviews
- Participate in QM/UM monthly meetings
- 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 implement them at the employee level.
- Reinforce clinical philosophy, programs, policies and procedures.
- Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.
Experience with the long-term special services (LTSS) management is required. Specialty in geriatrics is preferred.
5 years of experience in clinical practice/health care industry.
The minimum level of education desired for candidates in this position is an M.D. or D.O.
License and Certifications:
M.D. or D.O., Board Certification in an Aetna-recognized specialty, including post-graduate direct patient care experience.
Active and current Kansas State medical license without encumbrances (must obtain if do not currently have) Clinical Licensure: Board Certified MD 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. 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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