Medical Director – Medicaid

Role Overview

• This Medical Director role will be a "Work from Home" position primarily supporting the Aetna West Virginia plan, and the Southeast Region (FL, KY and LA).
• The Medical Director is part of a centralized team that supports the Medical Management staff and may support other health plans as needed.
• The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests.
• This position is primarily responsible for Utilization Management, including prior authorization and precertification 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.
• The Medical Director participates in a rotating on call schedule to provide 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 West Virginia state medical license without encumbrances as well as the ability to obtain Florida, Louisiana and Kentucky licenses.
• 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.

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.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.