The Southeast Regional Medical Director position reports to the Head of Regional Care Management. In this position the S RMD will have full and primary accountability for region-specific patient management, including utilization management and clinical sales support activities across all segments. This role will also work collaboratively with the regional network management team and medical economics unit. This position will help to identify and implement leading-edge initiatives to enhance the focus and discipline associated with patient/quality management and medical cost-effectiveness. In directing healthcare delivery for the region in a shared services model, this role will work closely with senior management to understand the business needs and strategies of the various market segments. Subsequently, this role will implement new initiatives to achieve a range of operating performance metrics. This position will provide input on the effective utilization of the associated with the region''s network contracts. This position will be guided by quantitative and qualitative metrics with respect to the delivery for medical and patient management initiatives. This process will be executed in concert with expense budgets, ensuring alignment with the overall business plans and objectives for the region and the company. The RMD can be located in any state of the SE Region (AL, AR, DC, FL, GA, LA, MD, MS, NC, SC, TN, VA, and WV). However, Work at Home (WAH) is not preferred.
The highest level of education desired for candidates in this position is a MD.
LICENSES AND CERTIFICATIONS
Medical/Board Certified, Internal Medicine is required
Medical/DEA License is required
Clinical / Medical/Management: >25 employees/4-6 Years
Medical Management/Medical Management - Physician Relations/7-10 Years
Leadership/Lead a complex or multifunctional organization/7-10 Years
General Management/Data analysis & interpretation/4-6 Years
Information Management/Business information analysis/4-6 Years
General Business/Turning Data into Information/MASTERY
Leadership/Developing and Executing Strategy/MASTERY
Leadership/Driving Strategic and Organizational Agility/MASTERY
Leadership/Driving a Culture of Compliance/MASTERY
Leadership/Engaging and Developing People/MASTERY
General Business/Consulting for Solutions/MASTERY
ADDITIONAL JOB INFORMATION
Report to the Head of Regional Care Management & collaborate with head of other regions to develop & execute both short- & long-range strategic plans for the Regional Healthcare Management organization across all business segments. Maintain an appropriate and effective organizational structure to support the business strategy & achieve desired outcomes. Provide input to network management for regional market network creation, contracting, fees, & all other related activities necessary to drive optimal results. Accountability for the regional Patient Management organizations, including the development, implementation & execution of PM strategy. Collaborate with National Medical Policy & National Quality Management Organizations to ensure PM execution is aligned with overall health policy, quality standards & strategy. Regional shared responsibility for field compliance & public relations. Develop & maintain relationships with local & state medical associations as well as hospital & physician organizations. Significant managed care leadership experience with demonstrated results leading broad scope initiatives & change. Substantial & demonstrated track record of management & leadership success over a range of healthcare delivery programs & operations. Candidates will have held regional accountabilities for impacting & enhancing healthcare delivery, as well as for the associated financial & operating performance metrics on behalf of an organization. A comprehensive knowledge of the healthcare marketplace, candidates will be conversant in diverse functional disciplines from both a strategic & tactical perspective. Candidates will understand the key competitive & market dynamics, & in this regard, will guide & oversee competitive & trends analysis, cognizant of the region-specific issues which exist in the delivery of healthcare programs. Significant understanding of the various types of health insurance & managed care products (HMO, PPO, POS and others), candidates will have in-depth knowledge of provider contracting, & network strategy and policies. A thorough understanding for the hospital, physician, & alternative provider systems, & will have a significant track record for impacting patient & quality management delivery models. Candidates will fully understand the key financial drivers & concepts which include, financial planning & analysis, budgeting, and expense management
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Offers to all candidates are contingent upon a background investigation - no individual with a felony drug conviction may be hired at this facility.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Job Function: Management
Job Function: Management
Aetna - 15 months ago
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