Medical DirectorPrimary Location: Berlin, NJ
Additional Locations: DE-Newark, DE-Wimington, NJ-Andover, NJ-Atlantic County, NJ-Bergen County, NJ-Berlin, NJ-Bridgewater, NJ-Cherry Hill, NJ-Franklin Township, NJ-Hudson County, NJ-Jersey City, NJ-Newark, NJ-Salem County, PA-Allentown, PA-Bethlehem, PA-Chester County, PA-Harrisburg, PA-Philadelphia County, PA-Pittsburgh, PA-West Chester Apply
59902Fundamental Components: 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 Background Experience: 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.
Required Skills: Benefits Management - Maximizing Healthcare Quality, Service - Providing Solutions to Constituent Needs Functional Skills: Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - General Management, Medical Management - Medical Management - Administration/Management, Medical Management - Medical Management - Concurrent Review, Medical Management - Medical Management - Physician Relations Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Education: Medical - Medical License (for all states) Potential Telework Position: Yes Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: 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.
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