Description
We are seeking a Medical Director to join our Aetna Duals Center of Excellence team. As a Medical Director, you will be part of a centralized team that supports Medical Management staff in ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This is a work-at-home position located anywhere in the US.
The Medical Director will work a full-time schedule, Monday to Friday, in Eastern Standard Time or Central Standard Time, 8:00 AM - 5:00 PM. You will also be expected to work 1 holiday and 8 weekend days (approximately 1 weekend per quarter) each year.
Key responsibilities include:
- Performing concurrent and prior authorization reviews with peer-to-peer coverage of denials
- Conducting appeals in 'base plans' and potentially participating in round-robin reviews based on 'same or similar specialty' needs
- Reviewing pharmacy coverage
- Participating in and leading rounds
Requirements:
- Minimum 3-5 years of clinical practice experience
- Two (2) + years of experience in managed care (Medicare and/or Medicaid)
- Experience with utilization management (preferred Medicare and/or Medicaid)
- 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
- Florida license or ability to obtain
Preferred qualifications:
- Previous experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System
- Licensed in or willing to obtain a license in at least one state where we have an Integrated plan
The typical pay range for this role is: $174,070.00 - $374,920.00 per year. This position is eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.