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Aetna Medical Director in Ft Lauderdale, Florida

Req ID: 64202BR

Job Description

Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Florida is looking for people like you who value excellence, integrity, caring, and innovation. As an employee, you ll join a team dedicated to improving the lives of our Medicaid members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Florida and we will support you all the way!

Aetna Better Health of X is looking for a medical director to join our team. This physician will participate in the development, implementation, and evaluation of clinical/medical programs.

Fundamental Components included but are not limited to:

In this role you will:

Perform daily review of individual cases from concurrent review and prior authorization processes, including denial decisions for cases that do not meet established criteria.

Provide medical review and support for case management and care coordination staff to ensure optimal care is rendered to our members according to the terms of the benefit members receive.

Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes.

Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams.

Consistently demonstrate the ability to serve as a model change agent and lead change efforts.

Be responsible for maintaining compliance with policies and procedures and implement them at the employee level.

Reinforce clinical philosophy, programs, policies and procedures.

Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.

Qualifications Requirements and Preferences:

2-3 years of experience in clinical practice/health care industry.

Previous managed care experience with an insurer/payor highly preferred, but not required

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Healthcare

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.