Jobs at Aetna – Medical Director

Job Description:

The medical director is a work-at-home position supporting the Aetna Medicaid line of business; primarily in the state of West Virginia but filling in covering other states when needed in our fully integrated plans (Behavioral & Physical Health) offering a variety of physical and behavioral health programs and services to its membership.

Job Responsibilities:

• Utilization management – The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• Appeals – The medical director will perform appeals in the “round robin” for multiple plans and be first line for urgent requests.
• Pharmacy coverage – The medical director will perform pharmacy reviews to cover for medical directors on PTO, leave, and as requested by plan leadership.
• The medical director will be the primary coverage for plans when a medical director is out on PTO, leave, or during a time of transition.

Job Requirements:

• Skills Benefits Management/Interacting with Medical Professionals-MASTERY
• Minimum 3-5 years of clinical practice experience in the health care delivery field as a psychiatrist.
• Proficiency with Microsoft Outlook, Word, Excel, PowerPoint, and Teams strongly preferred
• MD or DO
• Psychiatrist
• Child and Adolescence sub specialty
• Experience with managed care (Medicaid and Medicare preferred) utilization review is preferred.
• Substance abuse experience
• Must reside in the state of WV
• Board certification
• Preferred but not required managed care experience

Job Details:

Company: Aetna

Vacancy Type: Full Time

Job Location: Charleston, WV, US

Application Deadline: N/A

Apply Here

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