Senior Director, Clinical Solutions MD (Aetna Community Cares)Primary Location: Harrisburg, Pennsylvania
Additional Locations: PA-Harrisburg Apply
We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are. The Senior Medical Director is a member of the Aetna Community Care Management team. The SMD will participate in designing, developing and deploying the Aetna Community Care Model across markets and lines of business for the State of New Jersey and Eastern Pennsylvania. 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.
Contributes to business direction and strategic leadership in support of medical management programs.
Develops, implements, and promotes strategies, tactics, and programs that drive the delivery of quality healthcare in a cost effective manner.
Contributes to strategies, tactics and programs for care management, quality management, and community engagement for members, community Partners and providers.
Shares information on business operations, key trends, financial performance, and best practices with colleagues and customers.
Collaborates with other areas of Aetna to ensure the highest quality community care model is delivered to our members.
Ensures timely execution of all deliverables in accordance with due dates.
Assists in helping to develop new and innovative health related activities to meet the clinical mission, goals and philosophy of care for Aetna Community Care members, including digital paths.
Proactively evaluates and analyzes medical, pharmacy, behavioral health, and healthcare trend drivers and proposes clinical programs and/or improvements to effectively manage these trends for plan sponsors.
Represents Aetna Community Care at community activities and sales finalist meetings.
Prepares and recommends appropriate use and design of medical plans.
Advises Aetna Community Care Leaders on health information technology system needs; develops, recommends, and conduct special studies of health needs and priorities through interpretation of clinical data for the State of New Jersey.
Advocates for the Aetna Community Care model and serves as liaison to professional societies as appropriate.
Assists in the presentation of reports on medical management and quality initiatives to the Executive Leadership Team.
Must have an active and current medical license without encumbrances
Five (5) years of practice experience along with five (5) years of senior management experience in healthcare setting is preferred e.g. clinical practice/direct patient care; experience in case management, disease management, and quality management Medicare/government programs 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 specialist (medical or surgical) specialty.
Board Certification in Internal Medicine, Family Practice, Emergency Medicine, or Pediatrics is preferred; will consider qualified applicants from other medical specialties
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.
The highest level of education desired for candidates in this position is a MD or DO.
ADDITIONAL JOB INFORMATION
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.
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.
56339Potential Telework Position: No Percent of Travel Required: 25 - 50% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer
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