CVS Health Medical Director DSNP in Portland, Maine
POSITION SUMMARY / MISSION:
Aetna is as an industry leader in serving dual eligible populations by utilizing outstanding operating and clinical models in both our Dually Eligible Special Needs Plan (DSNP) and our Medicare-Medicaid Plan (MMP) programs. We collaborate with members, providers, and community organizations in pursuit of quality solutions that address the full continuum of our members’ health care and social determinant needs.
The Duals Care Management (CM) Medical Director will participate in crafting, developing and deploying our Models of Care across DSNP markets. They will facilitate active communication between members, physicians and administration ensuring program design effectiveness.
Join us in this exciting opportunity as we grow and expand DSNP into new markets across the country.
Provides clinical oversight of the Dual Eligible Special Needs Plan (DSNP) and Medicare-Medicaid Plan (MMP) care management teams and the Interdisciplinary Care Team (ICT) processes by participating in the development of members’ Individual Care Plans (ICP) and assisting care management staff as they support of members’ physical, behavioral and socioeconomic needs.
Partner closely with the Executive Director of Duals and other Duals Care Management leadership to collaborate across the enterprise and ensure that objectives are aligned, business strategies are delivered, and compliance and quality objectives are met.
Consults with plan medical staff regarding adverse determinations, addresses issues related to network providers, performs medical chart reviews, and conducts physician peer-to-peer discussions as needed for the development of ICPs.
Collaborates across the enterprise to ensure that the highest quality care is delivered to our members in an effective and efficient way.
Contributes to strategies, tactics and programs for care management and community engagement for members, community partners and providers.
Assists in developing new and innovative health-related activities to meet the clinical mission, goals and philosophy of care for the health plan’s dual members.
Collaborates with the Learning and Performance Team to develop clinical training for care management staff.
Ensures timely execution of all deliverables in accordance with due dates and Federal/state regulatory requirements.
Collaborates with department leadership and business analysts to interpret utilization data and proposes clinical programs and/or improvements to effectively lead trends.
3-5 years of Managed Care experience; Medicare and Medicaid including LTSS highly preferred
3-5 year of Care Management experience
Medicare/Medicaid/DSNP/MMP experience preferred
Ability to work efficiently in a highly matrixed organization / environment
Ability to engage at all levels, including physicians, vendors, community partners, administrative leaders, clinical leaders and staff.
Ability to be agile, manage multiple priorities, and adapt to change with passion
Ability to work virtually
EDUCATION AND CERTIFICATION REQUIREMENTS :
Active and current medical license (MD or DO) without encumbrances
Board Certification in an Aetna recognized specialty
Post-graduate direct patient care experience
Flexibility with work schedule to meet business needs
Work at Home with any location considered
ADDITIONAL JOB INFORMATION:
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. 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
Percent of Travel Required
0 - 10%
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.