Medical Director

This is a fully remote position, open to applicants in Alabama, +3 more locations.

📋 Description

• Supervise utilization review processes for health systems located in the Georgia and Gulf States region.

• Manage the utilization review and quality assessment of inpatient hospitalizations, prior authorizations, and appeals.

• Engage in the development, execution, and assessment of clinical and medical programs.

• Enhance Aetna’s medical management initiatives to meet member needs throughout the continuum of care.

• Assist Medical Management staff by providing prompt and consistent responses to both members and providers.

• Conduct or supervise prior authorizations, pre-certifications, concurrent reviews, peer-to-peer communications, first-level appeals, and special projects.

• Participate in committees as required.

• Collaborate and function as a member of the Medical Director team.

⛳️ Requirements

• A minimum of two (2) years of experience within a healthcare delivery system, including clinical practice and the healthcare industry.

• An active and current medical license free of any encumbrances.

• M.D. or D.O. degree.

• Active and current board certification in a specialty recognized by ABMS or AOA.

• Post-graduate experience providing direct patient care.

• Proficiency with Microsoft Outlook and Teams.

• Preferred: residency in Louisiana, Mississippi, Alabama, or Arkansas.

• Preferred: previous experience in utilization management with a health plan/payor.

• Preferred: prior experience as a Physician Advisor in a healthcare or hospital system focusing on utilization management.

• Preferred: board certification in Internal Medicine, Family Medicine, or Emergency Medicine.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that support physical, emotional, and financial well-being.