Medical Director – Aetna Duals Center of Excellence

This is a fully remote position, open to applicants in Illinois, +3 more states.

📋 Description

• Conduct concurrent and prior authorization reviews, including peer-to-peer discussions regarding denial coverage.

• Manage appeals within their designated 'base plans' and may engage in round-robin processes based on 'similar or same specialty' requirements.

• Execute pharmacy reviews.

• Actively participate in and have the capability to lead rounds.

⛳️ Requirements

• A minimum of 3-5 years of clinical practice experience is required.

• At least two (2) years of experience in managed care, specifically with Medicare and/or Medicaid.

• Prior experience in managed care (Medicare and Medicaid) utilization review is preferred.

• MD or DO degree; board certification in an ABMS or AOA recognized specialty is mandatory.

• An active and current state medical license without any encumbrances is essential.

• Possession of multiple state licenses is an advantage.

🏝️ Benefits

• Medical, dental, and vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• A comprehensive benefits package.