Get It Recruit - Healthcare hiring Medical Director Aetna Duals Center of Excellence - Remote | WFH in Springfield, Illinois, United States | LinkedIn (2024)
Medical Director Aetna Duals Center of Excellence - Remote | WFH
Get It Recruit - HealthcareSpringfield, IL
Get It Recruit - Healthcare Springfield, IL
1 month ago
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Join us at Health, where we're dedicated to infusing every aspect of health care with compassion and heart. Our mission is clear: to bring our heart to every moment of your health, ensuring that every individual receives personalized, convenient, and affordable care. Anchored in our heartfelt approach, we're committed to transforming health care for a changing world.
At the core of our culture are our Heart At Work Behaviors™, empowering every member of our team to contribute to our culture's evolution and drive innovation in health care solutions.
Position SummaryAs part of the Aetna Duals Center of Excellence (COE), we operate Duals Integrated Plans across various states, offering a range of physical and behavioral health programs to our members. We're currently seeking a Medical Director to join our centralized team, supporting our Medical Management staff by ensuring timely and consistent responses to member and provider inquiries related to precertification, concurrent review, and appeals. This is a remote position, open to candidates anywhere in the US, with the requirement to work Central Standard Time or Eastern Standard Time.
Key ResponsibilitiesUtilization Management: Conduct concurrent and prior authorization reviews, providing peer-to-peer coverage for denials.
Appeals: Handle appeals as necessary.
Pharmacy Coverage: Perform pharmacy reviews.
Required QualificationsMinimum 3-5 years of clinical practice experience.
Two (2)+ years of managed care experience (Medicare and/or Medicaid).
MD or DO; Board certification in an ABMS or AOA recognized specialty.
Active and current state medical license without encumbrances; multiple state licensure a plus.
Preferred QualificationsPrevious experience in Utilization Management/Claims Determination within a Health Plan/Payor or Hospital/Health System.
Licensed in or willing to obtain a license in at least one state where we have an Integrated plan.
EducationMD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).
Pay RangeThe typical pay range for this role is between $174,070.00 - $374,900.00 annually. Actual compensation will be determined based on experience, education, and other relevant factors. This position is also eligible for bonus, commission, or short-term incentive programs, as well as participation in the company's equity award program.
BenefitsIn addition to competitive compensation, we offer a comprehensive benefits package including medical, dental, and vision coverage. Eligible employees may enroll in our 401(k) retirement savings plan and Employee Stock Purchase Plan. We provide fully-paid term life insurance, short-term and long-term disability benefits, and various well-being programs. Educational assistance, development courses, and a store discount are also available. Employees enjoy Paid Time Off (PTO), paid holidays, and other time-off benefits consistent with relevant state law and company policies.
Come join our team and experience the rewards of working for an organization that cares deeply for its colleagues and communities.
Employment Type: Full-Time
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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