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Aetna Medical Director, Medicare VBC in Philadelphia County, Pennsylvania

Req ID: 65630BR

Job Description

The Medical Director is both an internally and externally facing Medicare position that will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish a competitive business advantage for Aetna. The Medical Director will interface with external Medicare provider partners to drive enhanced population health and optimize overall provider performance on quality, utilization and cost metrics. The Medical Director will also participate in the development, implementation, and evaluation of clinical/medical programs.

Fundamental Components included but are not limited to:

The VBC Medical Director will drive optimized performance and enhanced value by: • Forging strong relationships with external providers; • Establishing partnerships across the internal matrix with Network, internal clinicians and other subject matter experts; • Providing clinical expertise, leadership and guidance to the Medicare Provider Collaboration team; • Analyzing utilization and outcome data to identify gaps and actionable opportunities and communicating those opportunities with internal and external teams; • Participating in the development of action plans that promote population health, enhanced quality for members and overall performance improvement; and • Collaborating with local provider systems to influence care management programs.

Qualifications Requirements and Preferences:

2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Active and current state medical license without encumbrances M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience required, Family Medicine, Internal Medicine or Geriatrics preferred.. Managed Care experience preferred.


Medical - Board Certified, American Board Of Family Practice, Medical - Board Certified, American Board Of Internal Medicine, Medical - Medical License (for all states)

Functional Skills:

Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - General Management, Leadership - Act as company spokesperson to external constituents, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft SharePoint, Desktop Tool - TE Microsoft Excel

Required Skills:

Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, Leadership - Collaborating for Results

Desired Skills:

General Business - Demonstrating Business and Industry Acumen, Leadership - Anticipating and Innovating, Leadership - Developing and Executing Strategy

Additional Job Information:

This position will support the development and implementation of new care models supporting value based arrangements. Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America. We are developing solutions to improve the quality and affordability of healthcare. What we do may benefit future generations. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.