Medical Director Aetna Duals Center of Excellence
Core
Lead a centralized team supporting medical management staff for precertification, concurrent review, and appeals in Duals Integrated Plans across multiple US states.
Role type
Senior Medical Director (Utilization Management)
Builds
Timely and consistent responses to members and providers regarding authorization and appeals.
Domain
US Healthcare / Managed Care (Medicare/Medicaid)
Required skills
Utilization management, Peer-to-peer coverage, Appeals adjudication, Pharmacy coverage, Clinical practice, Managed care experience, Board certification, State medical licensure
Preferred skills
Experience in Utilization Management/Claims Determination, Multiple state licensure, Experience with Hospital Systems
Responsibilities
Perform concurrent and prior authorization reviews, Perform appeals for base plans, Perform pharmacy reviews, Lead rounds
Seniority
Senior, hands-on IC