Medical DirectorPrimary Location: Chicago, IL
Additional Locations: CO-Denver, CO-Englewood, CO-Greenwood Village, CO-Lakewood, IA-Cedar Rapids, IA-Urbandale, IL-Chicago, IL-Downers Grove, IL-Rockford, IL-Rolling Meadows, IN-Carmel, IND-Mumbai, IN-Indianapolis, KS-Beloit, KS-Dodge City, KS-Great Bend, KS-Manhattan, KS-Overland Park, KS-Syracuse, KS-Wellington, KS-Wichita, MI-Detroit, MI-Grand Rapids, MI-Kalamazoo, MI-Lansing, MI-Southfield, MN-Minneapolis, MN-Plymouth, MN-St Louis Park, MN-St Paul, MO-Chesterfield, MO-Grain Valley, MO-Jefferson City, MO-Kansas City, MO-Springfield, MO-St Louis, ND-Bismarck, NE-Lincoln, NE-Omaha, SD-Aberdeen, WI-Eau Claire, WI-Waukesha Apply
Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs.
Candidate's must reside and be licensed in one of the following states: IL, MI, IN, MN, WI, MO, KS, NE, CO, IA, SD, ND.
64447Fundamental 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: General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Demonstrating Business and Industry Acumen Functional Skills: Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Direct patient care (hospital, private practice) Technology Experience: Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, 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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