Aetna LTSS Medical Director (Aetna Better Health of KS) in Wichita, Kansas
Req ID: 70861BR
Aetna Better Health of Kansas is looking for an LTSS (long-term services and supports) clinical officer/medical director to join our team. This physician directs healthcare services for individuals of any age with physical, intellectual, and/or developmental disabilities. The LTSS CO/MD oversees and is responsible for all primary physical and behavioral health services provided to individuals receiving LTSS, and to comparable populations enrolled in KanCare, as well as all clinical activities pertaining to the operation of LTSS programs and services, including preventive care and the management and coordination of primary and other physical health services for these members.
The LTSS CO/MD is also responsible for working with the CMO, behavioral health medical director, pharmacy director, and behavioral supports director to ensure integration of physical and behavioral health services and supports and LTSS, as applicable, for individuals in each of these populations, and to oversee quality improvement initiatives regarding behavioral supports and the appropriate use of psychotropic medications in these individuals.
The LTSS Medical Director must live in the state of Kansas or be willing to relocate to Kansas and obtain a Kansas medical license.
Fundamental Components included but are not limited to:
Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established evidence-based criteria
Conduct daily hospital admission and complex discharge rounds
Direct LTSS population activities, including evaluating the need for these services and ensuring collaboration among providers
Conduct peer to peer discussions
Perform high dollar deep dive reviews
Participate in QM/UM monthly meetings
Provide medical review and support for case management and care coordination staff to ensure optimal care is rendered to our members according to the terms of the benefit members receive
Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes
Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams.
Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
Be responsible for maintaining compliance with policies and procedures and implement them at the employee level.
Reinforce clinical philosophy, programs, policies and procedures.
Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.
Qualifications Requirements and Preferences:
Experience with the long-term special services (LTSS) management is required. Specialty in geriatrics is preferred.
5 years of experience in clinical practice/health care industry.
The minimum level of education desired for candidates in this position is an M.D. or D.O.
License and Certifications:
M.D. or D.O., Board Certification in an Aetna-recognized specialty, including post-graduate direct patient care experience.
Active and current Kansas State medical license without encumbrances (must obtain if do not currently have)
Benefit eligibility may vary by position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.
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