Job Details: Medical Director

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Description: Integrity. Accountability. Quality. Commitment. That's the Aetna Way. Our values make Aetna a winning culture intent on transforming healthcare. We are looking for people who want to be a part of the solution. The Aetna Way.
ABOUT OUR COMPANY
Integrity. Accountability. Quality. Commitment. That's the Aetna Way. Our values make Aetna a winning culture intent on transforming healthcare. We are looking for people who want to be a part of the solution. The Aetna Way.

JOB MISSION 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.

RESPONSIBILITIES/REQUIRED SKILLS/EXPERIENCE
„X Onsite support of UM/CM programs
„X Onsite support of DM and Maternity program
„X Remote support of UM/CM/DM/Maternity programs in other AHM service centers (i.e., back up coverage)
„X Participation in the UM after hours call coverage (telephonic)
„X Active participation in the Clinical Medical Management Team activities, meetings, and projects
„X Active participation in clinical guidelines review, maintenance and development process
„X Occasional travel to support other operations in Chantilly, VA, Rolling Meadows, IL, and New York, NY

Production
„X UM/CM case reviews as referred by utilization review nurses or by quality department nurses (e.g. failure to meet medical necessity criteria, appeals and quality reviews)
„X Peer-to-peer discussions with attending providers by phone to discuss problematic cases for potential denials
„X Updates the ActiveAdvice computer system with clinical findings and decision rationale
„X Participate with Implementation Lead (Client Services) regarding client specific issues/problems
„X Participation in the planning and delivery of staff education
„X Prepare and conduct presentations as needed to prospective clients and business partners
„X Participation in clinical research and development for the purpose of updating and developing clinical content across all ActiveHealth clinical programs
„X Continuous self-education regarding changes in ActiveHealth Management (AHM) clinical standards and guidelines
„X Follow AHM clinical guidelines and standard operating procedures to ensure optimal outcomes of Care Considerations
„X Participation in continuous Quality Improvement (QI) activities, including participation on Quality Improvement Committees and other quality initiatives
„X Assists with evaluation of the specialty Physician Advisor Panel composition to ensure sufficient representation by clinical specialists and recruits Physician Advisor Panel members as needed
HOW TO APPLY

We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna. To learn more about this opportunity, visit us at www.aetna.com/working
Under requisition #, select 21925 to submit your resume.

We conduct pre-employment drug and background testing. No agencies, please.

Aetna is an equal opportunity/affirmative action employer.

Posting Date: Mar 27 08