TELECOMMUTE – NY, AZ, CA, GA, IL, MN, TX, PA Candidates need to be able to work in the City or State specified
Senior Medical Director
Aetna, a CVS Health Company has an outstanding opportunity for a Senior Medical Director.
This is a work-from-home remote-based role.
In this role as a Senior Medical Director you will lead the clinical aspects of clinical program development and medical risk analysis.
The Senior Medical Director serves as clinical lead on initiatives to ensure accurate documentation of chronic conditions and leverage clinical information to improve health care quality and outcomes. You will work across the Aetna and CVS enterprise in a highly collaborative partnership with multiple business units to drive better clinical outcomes and manage Aetna’s risk analysis activities. You will be responsible for identifying opportunities, driving execution and monitoring performance to achieve desired outcomes. Specific areas of work include:
Developing and implementing approaches to leverage clinical information to improve health care quality and outcomes. For example, collaborating with teams to integrate clinical information into algorithms that identify members for care management and making actionable clinical information available to provider partners (e.g., physicians, nurse practitioners, etc.) Optimizing the In-Home Assessment (IHA) Program in which clinicians complete an annual comprehensive assessment with members in their homes to improve clinical and Stars performance. Optimizing all processes aimed at accurately and thoroughly documenting chronic conditions and submitting information to CMS.
Developing educational materials and educating providers on how to accurately and thoroughly document chronic conditions. Participating in audits initiated by external bodies related to the documentation of chronic conditions Responding to information requests from Medicare market business and clinical leaders pertaining to the aforementioned bodies of work. Providing clinical expertise and business direction in support of creating or enhancing additional medical management programs as requested.
3 or more years experience in clinical practice
3 or more years administrative experience in the health care industry or managed care.
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.
Medical Risk Analysis background.
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Risk Management , Medical & Health , Doctor & Practitioner , Health Administration
NY, AZ, CA, GA, IL, MN, TX, PA Candidates need to be able to work in the City or State specified