Medical Director
Humana
Medical Director
CVS Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Arizona, California, Florida, Illinois, Kentucky, Louisiana
Visit company websiteSalary
💰 $174,070 - $374,920 per year
Job Level
Lead
About the role
- Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid managed care plans in multiple states... This role supports the Aetna Better Health of Kentucky primarily, and the Southeast Region (FL, LA and WV). This Medical Director will be a "Work from Home" position primarily supporting the Aetna Kentucky plan; but part of a centralized team that supports the Medical Management staff. The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and pre certification as well as concurrent review. Cases could focus on inpatient or outpatient, acute and post acute as well as peer to peer calls and first level appeals.
Requirements
- Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Active and current Kentucky state medical license without encumbrances as well as the ability to obtain a Florida, Louisiana and West Virginia. M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty; including post-graduate direct patient care experience Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred. Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus + -Health plan/payor Utilization Management / Review experience. -Electronic medical systems/record experience. -Managed Care experience. -Medicaid experience.
