✨ About The Role
- This position primarily supports the Aetna Better Health of Kentucky and the Southeast Region, including Florida, Louisiana, and West Virginia.
- The Medical Director will work from home and be part of a centralized team that supports the Medical Management staff.
- Responsibilities include ensuring timely responses to members and providers regarding precertification, concurrent review, and appeal requests.
- The role involves managing cases related to inpatient and outpatient care, including acute and post-acute settings.
- The Medical Director will engage in peer-to-peer calls and first-level appeals as part of their duties.
âš¡ Requirements
- The ideal candidate will have at least five years of experience in the healthcare delivery system, demonstrating a strong understanding of clinical practice and the healthcare industry.
- A current and active medical license in Kentucky is required, along with the ability to obtain licenses in Florida, Louisiana, and West Virginia.
- Candidates should possess an M.D. or D.O. degree and hold current board certification in an ABMS or AOA recognized specialty.
- Experience in Utilization Management, particularly in prior authorization and concurrent review, is essential for success in this role.
- The successful candidate will have a background in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics, which is preferred.