Medical Director

5 days ago


Missouri, United States CVS Health Full time
Job Summary

The Aetna Duals Center of Excellence (COE) is seeking a Medical Director to join our centralized team. This role will support the Medical Management staff in ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests.

Key Responsibilities
  • Perform concurrent and prior authorization reviews with peer-to-peer coverage of denials.
  • Conduct appeals in their base plan and in the round-robin based on same or similar specialty needs.
  • Participate in and lead daily rounds.
Requirements
  • Minimum 3-5 years of clinical practice experience.
  • Two (2) + years of experience in managed care (Medicare and/or Medicaid).
  • Experience with managed care (Medicare and Medicaid) utilization review preferred.
  • MD or DO; Board certification in an ABMS or AOA recognized specialty is required.
  • Active and current state medical license without encumbrances is required. Multiple state licensure a plus.
Preferred Qualifications
  • Previous experience in utilization management/claims determination with another health plan/payor or hospital system/health system.
  • Licensed in or willing to obtain license in at least one state where we have an Integrated plan.
Education

MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)

Compensation

The typical pay range for this role is $174,374.90. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors.



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