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Medical Director (Aetna One Advocacy) in Chandler, AZ

Primary Location: Chandler, AZ
Additional Locations: AZ-Casa Grande, AZ-Chandler, AZ-Glendale, AZ-Mesa, AZ-Phoenix, AZ-Scottsdale, AZ-Tempe, AZ-Tucson
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Description:
The Medical Director (MD) for Aetna One Advocacy is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical/business leader resource for external providers, plan sponsors, and regulatory agencies while working to achieve successful integration and effectiveness of the medical/care management programs. The Medical Director that fills this position will be a part of Aetna One Advocacy which is a high touch and extremely collaborative program. Aetna One Advocate is a dedicated team of clinical and service professionals empowered to take care of all aspects of a member’s health. Medical directors on this team are responsible for overseeing and assisting in the plan’s personalized, end to end member experience. The Aetna One Advocate model provides the member with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition.

In addition to the front-line medical director component of this role, 10% of this MD's time will be spent externally facing to assist in the continued growth of our business.

This position is based in AZ.

Aetna One Advocate (A1A) is a fully integrated population health and customer service solution for large plan sponsors. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members’ needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. We are the premiere service and clinical offering for Aetna nation-wide and create industry-leading solutions for our customers and members.





Fundamental Components:
  • Partner with other Advocate team members to holistically assess member’s needs
  • Collaborate with treating providers through personalized, creative solutions to help member’s meet their health care needs.
  • Lead the clinical staff in the coordination of quality care on behalf of members
  • Conduct educational and clinical rounds with A1A clinical staff
  • Provide clinical expertise and business direction in support of medical management and utilization review programs through participation in clinical team activities including precertification, concurrent review/discharge planning, case management, disease management and quality management
  • Provide clinical guidance in promoting member quality of care and reviewing/addressing potential lapses
  • Act to engage providers and facilities in improving the quality of care delivered to our members and assure that our shared relationships are maintained and improved
  • Proactively use data analysis and periodic assessments to identify opportunities for quality improvement
  • Work collaboratively with other functional areas that interface with medical management including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals.


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.

Required Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, General Business - Communicating for Impact, Sales - Knowing Customers

Desired Skills:
Benefits Management - Shaping the Healthcare System, General Business - Turning Data into Information

Functional Skills:
Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - Disease management

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint

Education:
Medical - Board Certified, National Board Of Medical Examiners

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

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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