Aetna Medical Director in St Louis, Missouri
Req ID: 60617BR
Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs.
Work at Home position once training is completed. Office based one day a week. (St. Louis Office)
Fundamental Components included but are not limited to:
Expands Aetna's medical management programs to address member needs across the continuum of care Supports the Medical Management staff ensuring timely and consistent responses to members and providers. Oversees utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise
Qualifications Requirements and Preferences:
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Active and current state medical license without encumbrances
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
Medical - Medical License (for all states)
Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - General Management, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff
Desktop Tool - Microsoft Exchange, Desktop Tool - Microsoft Explorer, Desktop Tool - TE Microsoft Excel
General Business - Communicating for Impact, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance
Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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.