Aetna Medical Director - Aetna Better Health of Ohio in New Albany, Ohio
Req ID: 50164BR
Aetna Better Health of Ohio (An Aetna Duals Eligible Medicaid Plan) is looking for a Medical Director to join our team. The Medical Director will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs.
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.
Reviews prior authorization and concurrent review cases and provides decisions on those cases regarding services to members.
Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
Acts as clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
EDUCATION / CERTIFICATION
The highest level of education desired for candidates in this position is a MD or DO.
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
Benefits Management/Maximizing Healthcare Quality/ADVANCED
Benefits Management/Understanding Clinical Impacts/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Leadership/Collaborating for Results/FOUNDATION
Benefits Management/Promoting Health Information Technology/ADVANCED
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Option for telework will be evaluated after a certain period of employment
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