Medical Director (Aetna Medicaid) 39357BR

Position Summary:
Aetna Better Health of Kentucky (Kentucky Medicaid Plan) is looking for two (2) Medical Directors to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. Both positions are open due to current Medical Directors being eligible for "Early Retirement Program". Some telework may be allowed once fully trained but the position is primarily office based.
In this role you will:
Reinforce clinical philosophy, programs, policies and procedures
Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established criteria.
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.
Communicate strategic plan and specific tactics to meet plan.
Ensure implementation of tactics to meet strategic direction for cost and quality outcomes.
Create direction and communicate a business case for change by focusing on and addressing key priorities to achieve business results.
Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
Be accountable for meeting the financial, operational and quality objectives of the unit.
Develop, initiate, monitor and communicate performance expectations.
Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
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 implements them at the employee level.
Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
Background /Experience:
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Previous managed care experience with an insurer / payer highly preferred.
The highest level of education desired for candidates in this position is an MD or DO.
License and Certifications:
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.Active and current state medical license without encumbrances

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