Medical Director (Aetna One Advocacy) in Chandler, AZPrimary Location: Chandler, AZ
Additional Locations: AZ-Casa Grande, AZ-Chandler, AZ-Glendale, AZ-Mesa, AZ-Phoenix, AZ-Scottsdale, AZ-Tempe, AZ-Tucson Apply
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.
- 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.
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