Medical Director (IlliniCare - Aetna Medicaid)Primary Location: Burr Ridge, IL
Additional Locations: IL-Burr Ridge Apply
The Medical Director will provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs. This position primarily supports IlliniCare (An Aetna owned Medicaid Plan); but could work in other plans throughout the country "when needed".
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 Aetna recognized specialty including post-graduate direct patient care experience.
69101Required Skills: General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices Functional Skills: Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Clinical coverage and policies, Medical Management - Medical Management - Disease management, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff, Medical Management - Medical Management - Quality Management Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Medical - Medical License (for all states) Potential Telework Position: No Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by 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.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, a CVS Health Company, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna, a CVS Health Company.Sign Up
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna, a CVS Health Company.