Job Description
Job Description
Aetna Medicaid is looking for a medical director to be part of a regional team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.
Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia.
The medical director is a work-at-home position supporting the Aetna Medicaid line of business in these sixteen states.
This position will primarily support the Aetna Better Health of Texas plan and would be part of the team, run daily rounds, build clinical programs, and participate in continuous quality improvement.
The medical directors duties include performing utilization management medical and pharmacy concurrent and prior authorization reviews, supporting service coordinators/care managers, appeals and quality of care case reviews, and rotating weekend coverage (one in six to seven weekends).
In addition to Texas duties, the medical director will also be part of a regional team consisting of the Maryland and Kansas plans and support other plans as needed.
Required Qualifications
Board Certification in a recognized specialty is required, preferably in Primary Care / Family Medicine
Minimum 3-5 years of clinical practice experience in the health care delivery field.
Licensure in Texas is required.
Additional licensing in Kansas will be necessary if hired.
Preferred Qualifications
Experience with managed care utilization review strongly preferred.
Education
MD licensure and board certification in a recognized specialty is required.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Aetna Medicaid is looking for a medical director to be part of a regional team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.
Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia.
The medical director is a work-at-home position supporting the Aetna Medicaid line of business in these sixteen states.
This position will primarily support the Aetna Better Health of Texas plan and would be part of the team, run daily rounds, build clinical programs, and participate in continuous quality improvement.
The medical directors duties include performing utilization management medical and pharmacy concurrent and prior authorization reviews, supporting service coordinators/care managers, appeals and quality of care case reviews, and rotating weekend coverage (one in six to seven weekends).
In addition to Texas duties, the medical director will also be part of a regional team consisting of the Maryland and Kansas plans and support other plans as needed.
Required Qualifications
Board Certification in a recognized specialty is required, preferably in Primary Care / Family Medicine
Minimum 3-5 years of clinical practice experience in the health care delivery field.
Licensure in Texas is required.
Additional licensing in Kansas will be necessary if hired.
Preferred Qualifications
Experience with managed care utilization review strongly preferred.
Education
MD licensure and board certification in a recognized specialty is required.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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