Medical Director – Aetna Duals Center of Excellence
Job Description:
• The Medical Director will support the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests.
• Perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• Perform appeals in their "base plans" and may round robin based on "same or similar specialty" needs.
• Conduct pharmacy reviews.
• Participate in and lead rounds.
Requirements:
• Minimum 3-5 years of clinical practice experience
• Two (2) + years of experience in managed care (Medicare and/or Medicaid)
• Experience with managed care (Medicare and Medicaid) utilization review preferred
• MD or DO; Board certification in an ABMS or AOA recognized specialty is required
• Active and current state medical license without encumbrances is required
• Multiple state licensure a plus
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
Apply Now
Apply Now
• The Medical Director will support the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests.
• Perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• Perform appeals in their "base plans" and may round robin based on "same or similar specialty" needs.
• Conduct pharmacy reviews.
• Participate in and lead rounds.
Requirements:
• Minimum 3-5 years of clinical practice experience
• Two (2) + years of experience in managed care (Medicare and/or Medicaid)
• Experience with managed care (Medicare and Medicaid) utilization review preferred
• MD or DO; Board certification in an ABMS or AOA recognized specialty is required
• Active and current state medical license without encumbrances is required
• Multiple state licensure a plus
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
Apply Now
Apply Now