Medical Director – Aetna Duals Center of Excellence

Job Description

Seeking a Medical Director to oversee Aetna's Duals Integrated Plans. Key responsibilities include: - Conducting concurrent and prior authorization reviews, providing peer-to-peer coverage of denials. - Handling appeals in their 'base plans' and collaborating on 'same or similar specialty' needs. - Performing pharmacy reviews to ensure appropriate medication use. - Actively participating in and leading medical rounds to guide patient care strategies.

Qualifications

Key requirements for this role include: 1. A minimum of 3-5 years of practical clinical experience. 2. Two (2) + years of managed care experience (Medicare and/or Medicaid). 3. Familiarity with managed care (Medicare and Medicaid) utilization review processes. 4. MD or DO degree with board certification in an ABMS or AOA recognized specialty. 5. An active and unrestricted state medical license. 6. Additional licensure in multiple states is advantageous.

Benefits

- Comprehensive medical, dental, and vision coverage to support your health needs. - Generous paid time off for relaxation and personal pursuits. - Retirement savings options to secure your financial future. - Wellness programs designed to promote your overall well-being. - A comprehensive benefits package tailored to meet diverse employee needs.