Medical Director - New England Region
Core
Overseeing utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals for health systems in the New England Region.
Role type
Senior Medical Director (Utilization Management)
Builds
Aetna's medical management programs and clinical/medical programs addressing member needs across the continuum of care.
Domain
Health Insurance / Utilization Management / Clinical Quality
Required skills
Utilization review, Quality evaluation, Prior authorization, Peer-to-peer calls, First level appeals, Clinical program development, Medical license management, Health care delivery system experience
Preferred skills
Physician Advisor experience, Health Plan/Payor UM experience, Internal Medicine/Family Medicine/Emergency Medicine board certification
Technologies
Microsoft Outlook, Microsoft Teams
Responsibilities
Oversee utilization review for health systems, Participate in development and implementation of clinical programs, Support Medical Management staff with timely responses to members and providers
Seniority
Senior, hands-on IC