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 vacanciesforyou.net
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