Medical Director – Medical Policy Ops, DRG

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Delivering clinical expertise to enhance the provision of high-quality, patient-centered medical care with an emphasis on clinical and payment policies.

• Conducting transactional reviews to support the appeals process.

• Engaging in the clinical claim review process.

• Determining covered benefits in both Commercial and Medicare settings.

• Collaborating in work groups as a clinical subject matter expert to identify and advocate for opportunities to enhance the quality and efficiency of healthcare services.

• Utilizing clinical coding and reimbursement knowledge to ensure adherence to Aetna policies and practices in relation to service and payment requests.

• Actively employing data analysis to pinpoint opportunities for quality improvement.

⛳️ Requirements

• A minimum of five (5) years of experience in the Health Care Delivery System, including Clinical Practice and Health Care Industry.

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

• An M.D. or D.O. degree, with Board Certification in a specialty recognized by the ABMS, along with post-graduate direct patient care experience.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Generous paid time off.

• Retirement savings options.

• Access to wellness programs.