Medical Director - Commercial
Description:
- Provide oversight for medical policy implementation
- Participate in the development, implementation, and evaluation of clinical / medical programs
- Expand Aetna's medical management programs to address member needs across the continuum of care
- Support the Medical Management staff ensuring timely and consistent responses to members and providers
- Oversee utilization review / quality assurance and be responsible for predetermination reviews
- Provide clinical expertise as well as directing case management when necessary
- Provide clinical expertise and business direction in support of medical management programs
- Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams
Requirements:
- Active and current state medical license without encumbrances
- M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience
- Previous UM experience with a Health Plan / Payor (Preferred)
- Board Certification in Internal Medicine, Family Medicine, Surgery Specialty (Preferred)
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
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility
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