Job Overview
Company:
Location:
Base Pay:
 $200,000 - $220,000 /Year
Other Pay:
Employee Type:
 Full-Time
Industry:
 Insurance
Manages Others:
 No
Job Type:
 Health Care
Req'd Education:
 Graduate Degree
Req'd Experience:
 At least 5 year(s)
Req'd Travel:
 Negligible
Relocation Covered:
 No
Reference ID:
27745002_307521422
 
  
Contact:
Not Available
Phone:
Not Available
Email:
Send Email Now
Fax:
Not Available
 

company overview

Aetna is one of the nation’s leading diversified health care benefits companies, serving members with information and resources to help them make better informed decisions about their health care.

Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans.

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Medical Director--High Point, NC    
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job description

ABOUT OUR COMPANY
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.


ABOUT OUR COMPANY
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.

JOB GROUP SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.

EDUCATION
The highest level of education desired for candidates in this position is a MD.

LICENSES AND CERTIFICATIONS
  • Medical License (MD) is required
  • Board Certification is required in a recognized specialty

    FUNCTIONAL WORK EXPERIENCES
  • Clinical / Medical: Direct patient care (hospital, private practice)
  • Clinical / Medical: Legal & benefit interpretation
  • Leadership: Act as company spokesperson to external constituents
  • Management: Management Operations
  • Clinical / Medical: Clinical coverage & policies

    REQUIRED SKILLS
  • Analyze and respond to provider healthcare policy and program questions (Advanced)
  • Analyze member feedback and other measures of quality (Advanced)
  • Identify medical trends and cost saving opportunities (Advanced)
  • Responds to plan sponsor inquiries (Advanced)
  • Responds to provider inquiries (Advanced)
  • Perform clinical audits (Mastery)

    DESIRED SKILLS
  • Effectively position Aetna against competitors (Advanced)
  • Support field sales and service staff with ad hoc requests for information to create value-added materials to market Aetna's capabilities (Advanced)
  • Engaging and Developing People (Foundation)
  • Assists in the organization of finals meeting-site visits and the preparation of customer-focused sales presentations (Advanced)

    POSITION SUMMARY
    The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive and cost effective medical care. The MD is a critical medical and business leader and contact for external providers, plan sponsors, and regulatory agencies and participates in the strategic medical management of local markets.

    The Dedicated Unit Medical Director will report to the Senior Medical Director, NCM Medical management Services.This person will provide medical director support in the Dedicated Unit located in High Point NC as well as back up coverage when necessary to other Dedicated Unit sites. Specific responsibilities include:

  • Maintains positive relations with the customer services y the dedicate unit site
  • Performs chart reviews ad makes medical necessity decisions for the unit
  • Participates in customer presentations, as needed, to support NA sales and marketing efforts.
  • Adheres to Aetna Policies & Procedures for timeliness/criteria for decision making.
  • Cross cover for other NA PM Medical directors.
  • Maintain collaborative relationships with other medical directors in Aetna
  • Leverage Aetinfo and PM databases and organization to develop value-added information for assigned customers.
  • Use of data to identify opportunities for quality improvement and to positively influence practice patterns.
  • Collaborates with Site Lead on unit initiatives.

    ADDITIONAL JOB INFORMATION
    The ideal candidate-
  • Possesses sound clinical knowledge
  • Possesses general knowledge of the health benefits business, clinical issues, trends and medical management.
  • Has ability to anticipate the customer's needs/concerns/reactions and proactively presents opportunities and options.
  • Demonstrates a bias for action consistent with strategy.
  • Can operate successfully in a highly matrixed and changing environment.
  • Lives or willing to relocate to High Point NC.
  • Is able to travel 0-10% as needed.
  • Has M.D. or D.O., Board Certification is required in a recognized specialty.
  • Maintains active and current state medical license without encumbrances.
  • Has a minimum of 2-3 years managed care experience.
  • Has 5 years of clinical practice experience (required)

    We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

    Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.


    • job Requirements

    ABOUT OUR COMPANY
    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.

    JOB GROUP SUMMARY
    The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.

    EDUCATION
    The highest level of education desired for candidates in this position is a MD.

    LICENSES AND CERTIFICATIONS
  • Medical License (MD) is required
  • Board Certification is required in a recognized specialty

    FUNCTIONAL WORK EXPERIENCES
  • Clinical / Medical: Direct patient care (hospital, private practice)
  • Clinical / Medical: Legal & benefit interpretation
  • Leadership: Act as company spokesperson to external constituents
  • Management: Management Operations
  • Clinical / Medical: Clinical coverage & policies

    REQUIRED SKILLS
  • Analyze and respond to provider healthcare policy and program questions (Advanced)
  • Analyze member feedback and other measures of quality (Advanced)
  • Identify medical trends and cost saving opportunities (Advanced)
  • Responds to plan sponsor inquiries (Advanced)
  • Responds to provider inquiries (Advanced)
  • Perform clinical audits (Mastery)

    DESIRED SKILLS
  • Effectively position Aetna against competitors (Advanced)
  • Support field sales and service staff with ad hoc requests for information to create value-added materials to market Aetna's capabilities (Advanced)
  • Engaging and Developing People (Foundation)
  • Assists in the organization of finals meeting-site visits and the preparation of customer-focused sales presentations (Advanced)

    POSITION SUMMARY
    The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive and cost effective medical care. The MD is a critical medical and business leader and contact for external providers, plan sponsors, and regulatory agencies and participates in the strategic medical management of local markets.

    The Dedicated Unit Medical Director will report to the Senior Medical Director, NCM Medical management Services.This person will provide medical director support in the Dedicated Unit located in High Point NC as well as back up coverage when necessary to other Dedicated Unit sites. Specific responsibilities include:

  • Maintains positive relations with the customer services y the dedicate unit site
  • Performs chart reviews ad makes medical necessity decisions for the unit
  • Participates in customer presentations, as needed, to support NA sales and marketing efforts.
  • Adheres to Aetna Policies & Procedures for timeliness/criteria for decision making.
  • Cross cover for other NA PM Medical directors.
  • Maintain collaborative relationships with other medical directors in Aetna
  • Leverage Aetinfo and PM databases and organization to develop value-added information for assigned customers.
  • Use of data to identify opportunities for quality improvement and to positively influence practice patterns.
  • Collaborates with Site Lead on unit initiatives.

    ADDITIONAL JOB INFORMATION
    The ideal candidate-
  • Possesses sound clinical knowledge
  • Possesses general knowledge of the health benefits business, clinical issues, trends and medical management.
  • Has ability to anticipate the customer's needs/concerns/reactions and proactively presents opportunities and options.
  • Demonstrates a bias for action consistent with strategy.
  • Can operate successfully in a highly matrixed and changing environment.
  • Lives or willing to relocate to High Point NC.
  • Is able to travel 0-10% as needed.
  • Has M.D. or D.O., Board Certification is required in a recognized specialty.
  • Maintains active and current state medical license without encumbrances.
  • Has a minimum of 2-3 years managed care experience.
  • Has 5 years of clinical practice experience (required)

    We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

    Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    We value leadership, creativity and initiative.  If you share those values and a commitment to excellence and innovation, consider a career with Aetna.

    How to apply
     
    To learn more about this opportunity, visit us at www.aetna.com/working . Under requisition # select 29506 and submit your resume. 
     
    We conduct pre-employment drug and background testing.
    Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.
     
    Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V

    Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.

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