Job Description: Ready to take your Medical Director skills to the next level with a Fortune 5 company? Check out this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia. Job Responsibilities: Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs and expand Aetna’s medical management programs to address member needs across the continuum of care. Support the Medical Management staff ensuring timely and consistent responses to members and providers. Oversee utilization review/quality assurance, directing case management. Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities and act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Be responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise Perform other regional and/or segment-level support duties as required. Job Requirements: Active and current state medical license without encumbrances M.D. or D.O., Board Certification in a ABMS recognized specialty including post-graduate direct patient care experience. Managed Care experience Active and current state medical license without encumbrances 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Healthcare Insurance experience Job Details: Company: Aetna Vacancy Type: Full Time Job Location: Louisville, KY, US Application Deadline: N/A Apply Here vacancyoptions.com
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