Medical DirectorPrimary Location: Plantation, FL
Additional Locations: AL-Birmingham, FL-Miami, FL-Orlando, FL-Plantation, GA-Atlanta, LA-Baton Rouge, LA-New Orleans, MS-Ridgeland Apply
The Medical Director will provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs.
Work At Home position after initial training. Florida / Georgia / Louisiana / Alabama or Mississippi
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 and 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.
LICENSES AND CERTIFICATIONS
Active unrestricted state medical license required
Board Certification in Aetna recognized specialty required
Functional - Medical Management/Medical Management - Administration/Management/1-3 Years
Functional - Medical Management/Medical Management - Concurrent Review/1-3 Years
Functional - Medical Management/Medical Management - Physician Relations/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Clinical / Medical/General Management/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
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.
Fundamental Components/Job Description:
60755Required Skills: Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance Desired Skills: Benefits Management - Interacting with Medical Professionals, Service - Improving Constituent-Focused Processes Functional Skills: Clinical / Medical - Concurrent review / discharge planning Technology Experience: Desktop Tool - Microsoft Exchange, Desktop Tool - Microsoft Explorer, Desktop Tool - TE Microsoft Excel 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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