Req ID: 17976BR
* This is a full time Work at Home position. One week out of every month you will be required to be in our Phoenix, AZ office.POSITION SUMMARY: The Senior Medical Director (MD), Provider Strategies, is responsible for leadership of strategic medical management activities which contribute to the performance of the markets and promotes quality of care for our members. Primary responsibilities include development of value based purchasing (VBP) strategies, support of current and development of future Accountable Care Organization (ACO) relationships and development and implementation of related medical programs/policies, enhancing relationships with providers and facilities, plan sponsors and regulatory agencies and acting as a key business partner in network development and strategic planning.
RESPONSIBILITIES:
- Provides clinical and business leadership in support of strategic business objectives.
- Responsible for development of value based purchasing (VBP) strategies.
- Responsible for support of current and development of future Accountable Care Organization (ACO) relationships.
- Responsible for design, development and implementation of related medical programs/policies, goals and objectives.
- Provides clinical leadership and peer-to-peer collaboration for establishing and enhancing relationships with providers and facilities, plan sponsors and regulatory agencies.
- Functions as a key business partner in network development and strategic planning.
- Provides clinical leadership for strategic collaboration, program design and quality strategies.
- Uses data analysis to identify opportunities for quality improvement and to positively influence practice patterns, plan sponsor trends or program designs.
- Develops and improves tools to support Aetna''s medical management programs.
- Partners with other medical management functional organizations to ensure consistency and standardization of policy and procedures.
- Works collaboratively with other functional areas that interface with medical management including, network, provider relations, informatics, member services, claims management and health care delivery.
EDUCATION and CERTIFICATION REQUIREMENTS:
- M.D. or D.O. from an accredited university.
- Completion of a Residency Training Program in a recognized primary care or specialist (medical or surgical) specialty.
- Board Certification in Internal Medicine, Family Practice, Surgery, or Pediatrics; will consider qualified applicants from other medical specialties.
- Must have an active and current medical license without encumbrances.
REQUIRED SKILLS:
- 3-5+ years experience in healthcare delivery system plus 3-5 years leadership and management experience required.
- Demonstrated ability to make strategic decisions based on a thorough understanding of industry issues, trends and the regulatory landscape.
- Demonstrated ability to create business strategy specific to VBP and ACO relationships and to interact successfully w/external stakeholders.
- Demonstrated appreciation of cultural diversity and sensitivity towards target populations.
- Sound clinical knowledge and recognized as a credible clinical resource.
- General knowledge of the health benefits business, clinical issues, trends and medical management, medical care delivery systems, utilization management, quality management, contracting, benefits interpretation, provider relations and customer service.
- Strong interpersonal and listening skills that bring out the best in medical management staff.
- Ability to work independently and adapt to team approach as necessary.
- Ability to build a high performing team by promoting a culture of energy and commitment, mentoring employees and supporting ongoing training and development of staff.
- Ability to successfully operate in a highly matrixed and changing environment.
- Effective and skilled public speaker and presenter.
- Strong oral and written skills.
- Ability to set and achieve goals.
- Ability to implement complex program and monitor implementation and modifications.
- Ability to manage multiple priorities and deadline in an expedient and decisive manner.
- Strong organizational skills.
- Comprehensive knowledge of Microsoft Office Suite.
- Leadership: Collaborating for Results and Driving a Culture of Compliance
- Benefits Management: Interacting with Medical Professionals, Maximizing Healthcare Quality, Encouraging Wellness and Prevention, Understanding Clinical Impacts and Supporting Medical Practice
- General Business/Demonstrating Business and Industry Acumen
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Health Care