Medical Director Aetna Duals Center Of Excellence - Remote Eligible

✨ About The Role

- The Medical Director will be part of a centralized team supporting Medical Management staff, ensuring timely responses to members and providers regarding precertification and appeals. - This role involves performing concurrent and prior authorization reviews, as well as leading daily rounds, emphasizing the need for strong leadership and communication skills. - The position requires the ability to work Eastern or Central Standard time from 8 AM to 5 PM, with occasional weekend or holiday calls to cover urgent cases. - The Medical Director will engage in pharmacy reviews, indicating a comprehensive understanding of medication management and its implications for patient care. - The role is fully remote, allowing for flexibility in work location while maintaining a focus on delivering high-quality healthcare services.

⚡ Requirements

- The ideal candidate will have a minimum of 3-5 years of clinical practice experience, demonstrating a strong foundation in medical knowledge and patient care. - A successful applicant will possess at least two years of experience in managed care, specifically with Medicare and/or Medicaid, showcasing their understanding of the healthcare system. - Candidates should hold an MD or DO degree and be board certified in an ABMS or AOA recognized specialty, ensuring they meet the necessary qualifications for the role. - An active and current state medical license without encumbrances is required, with multiple state licensure being a plus, indicating flexibility and adaptability. - Previous experience in Utilization Management or Claims Determination with another Health Plan or Hospital System is preferred, highlighting the importance of relevant industry experience.