Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognises physicians for their clinical quality and effective use of health care resources.
Job Details:
This is a remote-based (work at home) role based anywhere in the US.
Responsibilities:
- Direct daily work on Part C appeals (both provider and member/non-participating providers)
- Provide direct support to appeal nurses; supervision and participation in the Second Look Review (SLR) process
- Provide after-hours and weekend coverage on a rotational basis to support 24/7 appeals work
- IRE monitoring and tracking and Utilisation Management Strategy support
- Collaborative work with Medicare Quality and Compliance on an ongoing basis
- Develop subject matter expertise on Medicare policy for the enterprise
- Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilisation Management Staff
- Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency
Requirements:
- Two (2) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry
- Medical Licence (MD) or (DO)
- An Active state medical licence without encumbrances
- Board Certified in ABMS or AOA Recognised Specialty
Preferred Qualifications:
- Medical Management - Medicare Complaints, Grievance & Appeals experience
- Health Plan Experience Highly Preferred
Education:
- MD or DO
Pay Range: $174,070.00 - $374,920.00
Benefits: We offer a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.