Medical Director – Aetna One Advocate
Employment Information
Job Description
Medical Director role at CVS Health focusing on personalized member care and quality improvement. Collaborating with clinical and functional teams to drive healthcare solutions and support members.
Responsibilities:
- Partner with other Advocate team members to holistically assess member’s needs
- Collaborate with treating providers through personalized, creative solutions to help member’s meet their health care needs.
- Lead the clinical staff in the coordination of quality care on behalf of members
- Conduct educational and clinical rounds with A1A clinical staff
- Provide clinical expertise and business direction in support of medical management and utilization review programs through participation in clinical team activities including precertification, concurrent review/discharge planning, case management, disease management and quality management
- Provide clinical guidance in promoting member quality of care and reviewing/addressing potential lapses
- Act to engage providers and facilities in improving the quality of care delivered to our members and assure that our shared relationships are maintained and improved
- Proactively use data analysis and periodic assessments to identify opportunities for quality improvement
- Work collaboratively with other functional areas that interface with medical management including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals
Requirements:
- Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and current state medical license without encumbrances.
Benefits:
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access and many other benefits depending on eligibility
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