Aetna Medical Director (New Jersey) 45266BR in East Brunswick, New Jersey

Req ID: 45266BR

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 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. There are two (2) open positions in NJ. The other position with similar responsibilities is posted under job # 37221BR.

Promote quality, cost effective care on behalf of members utilizing their available benefits.

Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities in the execution of precertification, concurrent review/discharge planning, appeals, case management, disease management, and quality management, including direct participation with plan sponsors, providers, facilities and vendors as required.

Partner with medical management leadership to increase effectiveness of medical management programs and to promote the integration of other Aetna medical programs.

Provide clinical guidance in operating effective medical programs to promote member quality of care and in reviewing potential lapses in the quality of care.

Fundamental Components:

The Medical Director is part of a dynamic team working with other medical directors and nurses, network contractors and plan sponsor representatives to promote high quality effective care to our members in New Jersey.We are interested especially in physicians with expertise in understand health care needs of our Medicare Advantage members.The Medical Director works with our nurses to determine medical necessity for a wide range of medical services.The Medical Director interacts with the local medical community to promote the appropriate use of medical services for our members.There is also opportunity to participate with the broader clinical community at Aetna to advance our central mission of advocating for effective affordable health care for all our members.There are opportunities to enhance clinical knowledge through exposure to a wide range of medical expertise within the company.

BACKGROUND/EXPERIENCE:

3-5 years of experience in the health care delivery system e.g., clinical practice and health care industry. Demonstrated appreciation of cultural diversity and sensitivity towards target populations. Strong sense of being responsive to flexible job demands, compliance and ethical values an active medical license with current board certification is required

EDUCATION:

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

LICENSES AND CERTIFICATIONS:

Medical Management/ABMS/AOA - Internal Medicine is desired

Medical/Board Certified, American Board Of Internal Medicine is desired. Open to other specialties as well. Active Unrestricted State Medical Licensure in NJ is Required.

FUNCTIONAL EXPERIENCES:

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years

Functional - Medical Management/Medical Management - Precertification/1-3 Years

Functional - Medical Management/Medical Management - Concurrent Review/1-3 Years

TECHNOLOGY EXPERIENCES:

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

REQUIRED SKILLS:

Leadership/Collaborating for Results/FOUNDATION

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Supporting Medical Practice/ADVANCED

DESIRED SKILLS:

General Business/Turning Data into Information/ADVANCED

Benefits Management/Shaping the Healthcare System/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

ADDITIONAL JOB INFORMATION:

Aetna is at the forefront of the innovation revolution in health care today. The medical director can expect to be an active participant in that change We offer the opportunity to see the bigger picture in how health care is delivered not just in our local New jersey market but nationally as well.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

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.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.#LI-KK1

Job Function: Health Care