Medical Director – Medicaid

Job Description

Join Aetna as a Medical Director and manage Medicaid services from your home office, serving Louisiana and nearby states. Your primary duties involve Utilization Management, which includes handling prior authorizations, precertification processes, and concurrent reviews to ensure timely responses for both members and providers. This position also includes managing inpatient and outpatient cases, handling acute and post-acute care scenarios, conducting peer-to-peer calls, and overseeing first-level appeals. As part of the role, you will participate in an on-call rotation, providing necessary coverage during weekends and holidays.

Qualifications

1. Requires five or more years of experience within a Health Care Delivery System, such as in Clinical Practice or the Health Care Industry. 2. Must possess an active and current Louisiana state medical license without any encumbrances, with the ability to also obtain licenses in Florida, Kentucky, and West Virginia. 3. A M.D. or D.O. degree is essential, along with current and active Board Certification in an ABMS or AOA-recognized specialty, including hands-on direct patient care experience. 4. Preference for candidates with a specialty in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics. 5. Experience in health plan/payer Utilization Management/Review. 6. Proficiency in using electronic medical systems and records. 7. Previous Managed Care experience is required. 8. Prior Medicaid experience is essential. 9. Advantageous to have previous UM experience within a Health Plan/Insurer or experience as a Physician Advisor or within an Independent Review Organization.

Benefits

- Medical, dental, and vision coverage. - Paid time off. - Retirement savings options. - Wellness programs. - Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.