At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Ready to take your Medical Director skills to the next level with a Fortune 6 company? Check out this opportunity with Aetna, a CVS Health company! This is a remote based work from home role. The Aetna One Advocate model provides the member with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition. Some key daily activities: 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 Required Qualifications
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