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Aetna is now a CVS Health Company

Senior Director, Clinical Solutions Medical Director

Primary Location: Phoenix, AZ
Additional Locations: AZ-Glendale, AZ-Mesa, AZ-Phoenix, AZ-Scottsdale, AZ-Tempe
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Description:
The Clinical Solutions Medical Director for Mercy Care Arizona will develop, implement, support, and promote population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare to establish a sustainable competitive business advantage for Aetna.

These strategies, policies, and programs are comprised of care management, utilization management, quality improvement, network management as well as clinical coverage protocol. The Medical Director will be provider and patient facing and have fluency in data analytics.



Fundamental Components:
Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes.

Direct the utilization review process and oversee the quality of utilization determinations. Ensure compliance with clinical goals through monitoring care management performance.

Responsible for overall medical policies of the unit to ensure the appropriate and most cost effective medical care is received, and for the day-to-day management of medical management staff.

Responsible for recommending changes and enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols.

Develops, implements, and interprets medical policy including medical necessity criteria, clinical practice guidelines, and new technology assessments.

Leads clinical staff in the coordination of quality care .

Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.

Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.

Responsibility for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

Expands Aetna's medical management programs to address member needs across the continuum of care


Background Experience:
Demonstrated experience in population health management and managed carePassion and ability to influence and drive better outcomes in healthcare delivery.Understanding of Value Based Contracting/Accountable Care and how this relates to improving the quality of care for our members through collaboration.5 years in a Healthcare Delivery System Board Certified MD or DO

Additional Job Information:
Demonstrated comfort with rapidly changing technology for engagement and analytics.Demonstrated transformation/change management skills and experience.Demonstrated leadership qualities that inspire and develop others.Commitment to coaching and collaborating.Exceptional oral and written communication skills.

Potential Telework Position:
No

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.

Click To Review Our Benefits (PDF)

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