Medical Director-Medicaid
New
A
AetnaManaged Care
You can work from anywhere in the United States.Full-TimeSenior
Salary$174,070.00 - $374,920.00
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Job Details
- Experience
- 5+ years of post-residency clinical practice and direct patient care experience.
- Required Skills
- EHR
Requirements
- M.D. or D.O. degree
- Current, active Board Certification in an ABMS- or AOA-recognized specialty
- 5+ years of post-residency clinical practice and direct patient care experience
- Active, unrestricted Virginia medical license
- Ability to obtain and maintain medical licenses in Maryland, New Jersey, New York, and Pennsylvania
- Experience with utilization management, prior authorization, and concurrent review (preferred)
- Experience with Medicaid and managed care plans (preferred)
- Experience using electronic health records and clinical documentation systems (preferred)
Responsibilities
- Perform utilization management and medical necessity reviews
- Conduct prior authorization and precertification determinations
- Manage concurrent reviews for inpatient and outpatient services
- Oversee acute and post-acute care reviews
- Facilitate peer-to-peer consultations with treating providers
- Conduct pharmacy reviews and first-level appeal determinations
- Collaborate with multidisciplinary clinical and operational teams
- Participate in a rotating on-call schedule including weekends and holidays
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