Medical Director - Georgia Gulf States
Core
Overseeing utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals for health systems in the Georgia and Gulf States region.
Role type
Senior Medical Director (Utilization Review)
Builds
Aetna's medical management programs and clinical quality initiatives
Domain
Health Insurance / Utilization Management
Required skills
Inpatient utilization review, Quality evaluation, Prior authorization management, Appeals handling, Clinical program development, Medical license management
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, Develop and implement clinical/medical programs, Support Medical Management staff with prior authorization and appeals
Seniority
Senior, hands-on IC