United States Job details
POSITION SUMMARY:
Aetna Better Health of Ohio (An Aetna Duals Eligible Medicaid Plan) is looking for a Medical Director to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs.
This can be a Work at Home position / Previous Managed care Experience Desired.
Expands Aetna's medical management programs to address member needs across the continuum of care. This may include Medicare-Medicaid Dual Eligible members in Ohio, Illinois, Michigan, and Virginia.
Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
Reviews prior authorization and concurrent review cases and provides decisions on those cases regarding services to members.
Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
Acts as clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
Requirements
- Active and current state medical license without encumbrances.
- Board Certification in an Aetna recognized specialty including post-graduate direct patient care experience.
- The highest level of education desired for candidates in this position is a MD or DO.
- Clinical Practice and Health Care Industry.
- BACKGROUND/EXPERIENCE: Two (2)- Three (3) years of experience in Health Care Delivery System e.g.
- This can be a Work at Home position / Previous Managed care Experience Desired.