Aetna Medical Director (Aetna Medicaid) in Phoenix, Arizona
Req ID: 51470BR
Aetna Medicaid is looking for Medical Directors to be part of a centralized pool of Medical Directors that support the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification and appeal requests. The Medical Director will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Aetna operates Medicaid managed care plans in 15 states; Arizona, California, Florida, Illinois. Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia.
The Medical Director is a Work at Home position supporting the Aetna Medicaid Line of Business in these 15 states offering a variety of physical and behavioral health programs and services to its membership.
These positions will primarily support utilization management transactional reviews such as Medical and Pharmacy Prior Authorization including weekend coverage when assigned, as well as Appeals, NICU case reviews and quality of care case reviews.
Background / Experience:
Minimum 3-5 years of experience in the health care delivery system e.g., clinical practice and health care industry.
Managed Care Experience Preferred
Medicaid Experience Preferred
The highest level of education desired for candidates in this position is a MD or DO
Certification / Licenses:
Active and current state medical license without encumbrances is required
Board Certification in a recognized specialty is required
Functional - Medical Management/Medical Management - Precertification/1-3 Years
Functional - Medical Management/Medical Management - Quality Management/1-3 Years
Functional - Medical Management/Medical Management - Case Management/1-3 Years
Functional - Medical Management/Medical Management - Complaints, Grievance & Appeals/1-3 Years
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Aetna Applications/QNXT/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/MASTERY
Benefits Management/Promoting Health Information Technology/ADVANCED
Benefits Management/Maximizing Healthcare Quality/MASTERY
Benefits Management/Supporting Medical Practice/ADVANCED
Benefits Management/Encouraging Wellness and Prevention/MASTERY
Finance/Managing Aetnas Risk/MASTERY
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
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.