Medical Director – Medicaid

Description: • Medical Director for Aetna (a CVS Health company) supporting Medicaid managed care plans • Work from home position primarily supporting Aetna Better Health of Florida and the Southeast Region (KY, LA, WV) • Part of a centralized team supporting Medical Management staff and other health plans as needed • Ensure timely and consistent responses to members and providers for precertification, concurrent review, and appeals • Responsible for Utilization Management including prior authorization, precertification, and concurrent review • Manage cases across inpatient and outpatient, acute and post-acute care, peer-to-peer calls, and first-level appeals • Participate in a rotating on-call schedule providing weekend and holiday coverage Requirements: • Five or more years of experience in Health Care Delivery System (e.g., Clinical Practice and Health Care Industry) • Active and current Florida state medical license without encumbrances • Ability to obtain Kentucky, Louisiana and West Virginia medical licenses • M.D. or D.O. • Current and Active Board Certification in ABMS or AOA recognized specialty • Post-graduate direct patient care experience • Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics specialty preferred • Prior utilization management (UM) experience at a health plan/insurer or experience as a Physician Advisor or with an Independent Review Organization (preferred) • Electronic medical systems/records experience (preferred) • Managed Care experience (preferred) • Medicaid experience (preferred) • Ability to participate in rotating on-call schedule for weekend and holiday coverage Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off and flexible work schedules • Family leave and dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access • Competitive wages and other benefits depending on eligibility Apply tot his job Apply To this Job