Aetna Medical Director (Telecommute) in Miami, Florida
Req ID: 45475BR
The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus clinical and payment policy. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential.
Basic responsibilities of this Medical Director include support of the appeal process, clinical claim review process, precertification, and predetermination of covered benefits in the commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas.
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
M.D. or D.O., Active and current state medical license without encumbrances.
Foundational baseline skills include Medicine, Health Policy, Epidemiology, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems
The highest level of education desired for candidates in this position is a MD.
LICENSES AND CERTIFICATIONS
Medical License (MD/DO) - required
Board Certification is required
Functional - Medical Management/Medical Management - Clinical coverage and policies/
Functional - Medical Management/Medical Management - Complaints, Grievance & Appeals/
Technical - Aetna Applications///
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Maximizing Work Practices/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Considered for any US location; training period in the office may be required
ADDITIONAL JOB INFORMATION
This is an opportunity to improve the quality, cost and access to care for members insured by the country's third largest private insurer. The ideal candidate will enjoy working with an innovative and competitive team of clinicians dedicated to the development and consistent application of clinical and payment policies in a rapidly changing healthcare environment. To be successful in this position, the medical director must have excellent skills in desktop software systems such as word processing and spreadsheet applications, as well an ability to work in multiple systems daily. The medical director must be able to function effectively in a complex and challenging decision-making role, applying clinical judgment to do the right thing for the right reasons.
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