Medical Director

We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Virginia, while also providing support across the Northeast Region and other health plans as needed.

In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include:

• Utilization Management and medical necessity reviews
• Prior authorization and precertification determinations
• Concurrent review for inpatient and outpatient services
• Acute and post-acute care reviews
• Peer-to-peer consultations with treating providers
• Pharmacy reviews and first-level appeal determinations
• Collaboration with multidisciplinary clinical and operational teams

The Medical Director also participates in a rotating on-call schedule that includes weekend and holiday coverage.

Required Qualifications:

• M.D. or D.O. degree with current, active Board Certification in an ABMS- or AOA-recognized specialty
• 5+ years of post-residency clinical practice and direct patient care experience
• Active, unrestricted Virginia medical license
• Ability to obtain and maintain medical licenses in Maryland, New Jersey, New York, and Pennsylvania

Preferred Qualifications:

• Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics
• Prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor capacity
• Medicaid and managed care experience
• Experience with medical necessity review, prior authorization, concurrent review, appeals, and peer-to-peer consultation
• Experience using electronic health records and other clinical documentation systems

Pay Range: $174,070.00 - $374,920.00

This position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.