Aetna Medical Director in Charleston, West Virginia
Req ID: 41030BR
Aetna Better Health of West Virginia is looking for a Medical Director to join our team. We are looking for someone that has managed care experience with a Health Plan or is willing to learn the managed care side of the business. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs. The Medical Director will report directly to the Chief Medical Officer.
In this position you will:
Expand Aetna's medical management programs to address member needs across the continuum of care.
Support the Medical Management staff ensuring timely and consistent responses to members and providers.
Oversee utilization review/quality assurance as well as direct case management.
Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
Act as the lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Be responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
2-3 years of experience in a Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
Active and current state medical license without encumbrances or restrictions.
The highest level of education desired for candidates in this position is a MD.
Telework (WAH) after the initial orientation and education with the occasional need to be in the office or at off-site locations as dictated by meetings "may be" available for the candidate. This position will be located in the office with (WAH) potential at appropriate time.
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care