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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