Medical Director – Aetna Duals Center of Excellence

Job Description:

  • The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials.
  • The medical director will perform appeals in their “base plans” and may round robin based on “same or similar specialty” needs.
  • The medical director will perform pharmacy reviews.
  • The medical director will participate in and be able to lead rounds.

Requirements:

  • Minimum 3-5 years of clinical practice experience
  • Two (2) + years of experience in managed care (Medicare and/or Medicaid)
  • Experience with managed care (Medicare and Medicaid) utilization review preferred
  • MD or DO; Board certification in an ABMS or AOA recognized specialty is required
  • Active and current state medical license without encumbrances is required
  • Multiple state licensure a plus

Benefits:

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • comprehensive benefits package designed to support physical, emotional, and financial well-being of colleagues and their families
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