Medical DirectorPrimary Location: Richmond, VA
Additional Locations: VA-Richmond Apply
Aetna Better Health of Virginia, Inc. (ABHVA) is hiring a Medical Director, for our Integrated Care Program for Medicaid and Long Term Systems and Supports members within the Commonwealth. You will implement and supervise delivery and coordination of all services and benefits under the contract between Aetna Better Health (ABH), the Virginia Department of Medical Assistance Services, and CMS. DMAS stated, Virginia envisions a Medicaid delivery system where high value care is the norm and even the most medically complex enrollees with significant behavioral, physical, sensory, and developmental disabilities can live safely and thrive in the community.
ABHVA shares this vision to create a transformational system supporting all Medicaid and MLTSS members, with the highest quality care in the least restrictive environment manner. Integrated Care Management accomplishes this objective by integrating physical and behavioral health, addressing social determinants of health, and minimizing the complexity and fragmentation of services. Fundamental to the Fully Integrated System of Care and Integrated Care Management is ongoing collaboration and alignment among all internal and external stakeholders.
Candidate must live in VA.
VA license required or ability to get a VA license.
This is an in office and work at home position; 2-3 days work at home
64233Fundamental Components: In this role you will:
Provide collaborative oversight for medical policy implementation and utilization management services.
Participate in the development, implementation, and evaluation of clinical/medical programs.
Provide health leadership, oversight and consultation for the QI and UM programs including development, implementation, evaluation and compliance.
Oversee the utilization review process and oversee the quality of utilization determinations.
Ensure compliance with clinical goals through monitoring care management performance.
Develop, implement and interpret medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments.
Promote the Bio-Psycho-Social model for integrated care management.
Under the direction of the Chief Medical Officer (CMO), Review prior authorizations for medical necessity.
Under the direction of the Chief Medical Officer (CMO) recruit, train, supervise and evaluate the quality of medical staff and any physician advisors.
Participate regularly in the Interdisciplinary Care Management Rounds.
Serve as a subject matter expert and liaison with State Medicaid and CMS leadership.
Coordinate collaborative relationships with Community Mental Health Centers (CMHCs), Federally Qualified Healthcare Clinics (FQHCs) and various Advocacy Groups.
Background Experience: 2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Active and current state medical license without encumbrancesM.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience. Additional Job Information:
Education: Medical - Board Certified, American Academy Of Family Phy, Medical - Board Certified, Internal Medicine, Medical - Board Certified, Pediatrics 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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