Medicare Medical Director, Quality Measures
Aetna - New York, NY

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The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management, quality and efficiency programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical and business leader, contact for external providers and plan sponsors, and participates in strategic medical management. This position focuses on activities to support Medicare-specific quality measures (e.g., CMS star ratings and HEDIS measures), clinical improvement strategies, provider engagement to drive change, and creation of strategic business/clinical initiatives that result in measurable improvement for clinical quality in the Aetna Medicare population.

The highest level of education desired for candidates in this position is a MD.

Medical/Medical License (MD) is required

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Medical Management/Medical Management - Quality Management/4-6 Years

Leadership/Driving a Culture of Compliance/FOUNDATION
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Encouraging Wellness and Prevention/ADVANCED
General Business/Communicating for Impact/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED

The medical director will be an important member of the Medicare team, working closely with our national Stars, Medical Management, Medicare Clinical Operations, and Quality Management teams. The ability to effectively communicate with both clinical leaders/managers within the organization, as well as external providers, in addition to interacting with key business managers/leaders will be expected. Fundamental components of the position include:
  • Proactively use data analysis to identify opportunities for quality improvement.
  • Collaborate with partners in the medical management and Stars leadership team to increase effectiveness of quality management programs
  • Work with performance data that includes claims-based metrics, HEDIS metrics, and others.
  • Review, clinically interpret, and identify clinical quality opportunities with specific provider groups
  • Execute initiatives within Aetna and provider groups to drive improvement
  • Understand pay-for-performance programs, national quality programs, and the Medicare Stars system
  • Demonstrate the ability to work within and lead, as necessary, teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company.
  • Participate in workgroups, committees, project teams and strategic planning for the company in its mission to deliver quality care.
  • Travel to provider sites as needed for recurring meetings that occur on a regular basis
  • Medical License (MD)
  • Active and current Board Certification in an American Board of Medical Specialties (ABMS) approved specialty is required; Internal Medicine, Family Practice or Emergency Medicine desired; will consider qualified applicants from other medical or surgical specialties.
Other desired skills:
  • Sound clinical knowledge and recognized as a credible clinical resource.
  • 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 successfully operate in a highly matrixed and changing environment.
  • 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.
  • Comprehensive knowledge of Microsoft Office Suite.
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.

Aetna does not permit the use of tobacco related products or drugs in the workplace.

Job Function: Health Care

Aetna - 21 months ago - save job - copy to clipboard
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Aetna is about more than just doing a job. This is our opportunity to re-shape health care for America and across the globe. We are...