Medical Director

• Lead, coach, and develop a national team of clinicians across National Accounts, Large Group, and Public & Labor segments
• Cultivate relationships with brokers, consultants, and plan sponsors
• Lead clinical sales activities for high-profile prospects
• Improve team operations, coverage, prioritization, preparation, and materials
• Define the team coverage model and allocate clinical capacity based on pipeline value, retention risk, and strategic importance
• Set standards for clinical narratives, presentation materials, and meeting preparation
• Own hiring, onboarding, performance management, development planning, and succession
• Serve as senior clinical leader for finalist meetings, RFP responses, and clinical strategy sessions
• Develop strategic clinical messaging and articulate Aetna’s clinical differentiation
• Keep Field teams current on Aetna’s clinical programs through briefings and training
• Translate Aetna’s clinical program portfolio into prospect-specific value narratives
• Support retention and growth through strategic client reviews, clinical roadmaps, and outcomes and affordability discussions
• Interpret client-specific utilization, cost, and quality data and recommend clinical program actions
• Own producer engagement with benefits consulting firms, brokers, and general agents
• Lead clinical responses to consultant surveys, market scans, and program and vendor assessments
• Represent Aetna at consultant forums, market events, industry conferences, and employer coalitions
• Capture and channel customer, producer, and Field feedback into product and clinical roadmaps
• Surface competitive gaps and emerging plan sponsor requirements
• Maintain command of Commercial market dynamics, competitor strategy, health policy, and clinical program landscapes
• Represent Commercial Medical Affairs in governance forums and cross-functional working groups
• Ensure externally presented clinical claims are evidence-based, accurate, and defensible

Executive Medical Director, Clinical Business Solutions

• Architect and lead an AI-first technology platform for proactive, predictive, and continuous health management across the member journey
• Serve as technology lead for Clinical Innovation, aligning engineering, AI, and data capabilities with the Chief Medical Officer’s vision and long-term health strategy
• Shape the technical strategy and architecture for an extensible platform integrating AI, automation, and clinical insights into member interactions
• Assess emerging technologies, market trends, and partner ecosystems and drive adoption of next-generation AI models and interoperable frameworks
• Integrate multi-source data, including EMR, HIE, claims, and behavioral data, with analytics, engineering, and clinical teams
• Design and deploy AI-driven health coaching, behavioral nudges, and digital interventions
• Operationalize AI-powered guided assistance and care coordination across care pathways
• Integrate the AI platform with EMR, HIE, Campaign Management, Case Management, Administrative, and Contact Center systems
• Ensure adherence to AI governance, model transparency, clinical safety, security, and responsible-AI standards
• Drive scalability, performance, reliability, resilience, and continuous improvement of AI-enabled workflows and services
• Establish closed-loop intelligence to monitor performance, measure intervention effectiveness, and refine models
• Lead and mentor teams and foster continuous innovation in generative AI, digital twins, and multimodal data intelligence
• Collaborate with product, engineering, data science, and clinical teams to operationalize innovation and deliver measurable enterprise impact

Senior Director, Clinical Innovation – AI

• Provide clinical expertise to promote high-quality, constituent-focused medical care, with a focus on clinical and payment policy
• Perform transactional reviews supporting the appeal process, clinical claim review process, and predetermination of covered benefits in Commercial and Medicare environments
• Provide subject matter expertise in clinical and payment policy to support clinical and business direction
• Participate in work groups as a clinical subject matter expert to identify and promote opportunities to improve quality and efficiency of health care services
• Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
• Use data analysis to identify quality improvement opportunities and positively influence effective delivery of quality care services
• Serve as a subject matter expert, internal consultant, and payment policy contributor
• Work within and lead diverse teams of health delivery professionals to manage business objectives
• Collaborate with functional areas

Medical Director jobs in Connecticut

Executive Medical Director, Clinical Business Solutions

Senior Director, Clinical Innovation – AI

Medical Director – Medical Policy & Operations