Medical Director Aetna Duals Center of Excellence - Remote | WFH
Get It Recruit - Healthcare Springfield, IL
Get It Recruit - Healthcare Springfield, IL
1 month ago
See who Get It Recruit - Healthcare has hired for this role
Get It Recruit - Healthcare Springfield, IL
1 month ago
- Report this job
Join us at Health, where we're dedicated to infusing every aspect of health care with compassion and heart. Our mission is clear: to bring our heart to every moment of your health, ensuring that every individual receives personalized, convenient, and affordable care. Anchored in our heartfelt approach, we're committed to transforming health care for a changing world.
At the core of our culture are our Heart At Work Behaviors™, empowering every member of our team to contribute to our culture's evolution and drive innovation in health care solutions.
Position SummaryAs part of the Aetna Duals Center of Excellence (COE), we operate Duals Integrated Plans across various states, offering a range of physical and behavioral health programs to our members. We're currently seeking a Medical Director to join our centralized team, supporting our Medical Management staff by ensuring timely and consistent responses to member and provider inquiries related to precertification, concurrent review, and appeals. This is a remote position, open to candidates anywhere in the US, with the requirement to work Central Standard Time or Eastern Standard Time.
Key ResponsibilitiesUtilization Management: Conduct concurrent and prior authorization reviews, providing peer-to-peer coverage for denials.
Appeals: Handle appeals as necessary.
Pharmacy Coverage: Perform pharmacy reviews.
Required QualificationsMinimum 3-5 years of clinical practice experience.
Two (2)+ years of managed care experience (Medicare and/or Medicaid).
MD or DO; Board certification in an ABMS or AOA recognized specialty.
Active and current state medical license without encumbrances; multiple state licensure a plus.
Preferred QualificationsPrevious experience in Utilization Management/Claims Determination within a Health Plan/Payor or Hospital/Health System.
Licensed in or willing to obtain a license in at least one state where we have an Integrated plan.
EducationMD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).
Pay RangeThe typical pay range for this role is between $174,070.00 - $374,900.00 annually. Actual compensation will be determined based on experience, education, and other relevant factors. This position is also eligible for bonus, commission, or short-term incentive programs, as well as participation in the company's equity award program.
BenefitsIn addition to competitive compensation, we offer a comprehensive benefits package including medical, dental, and vision coverage. Eligible employees may enroll in our 401(k) retirement savings plan and Employee Stock Purchase Plan. We provide fully-paid term life insurance, short-term and long-term disability benefits, and various well-being programs. Educational assistance, development courses, and a store discount are also available. Employees enjoy Paid Time Off (PTO), paid holidays, and other time-off benefits consistent with relevant state law and company policies.
Come join our team and experience the rewards of working for an organization that cares deeply for its colleagues and communities.
Employment Type: Full-Time
-
Seniority level
Mid-Senior level -
Employment type
Full-time -
Job function
Health Care Provider -
Industries
Human Resources Services
Referrals increase your chances of interviewing at Get It Recruit - Healthcare by 2x
See who you know
Get notified about new Medical Director jobs in Springfield, IL.
Sign in to create job alert
Similar jobs
-
Medical Director
Medical Director
Vatica Health
United States
-
Medical Director
Medical Director
CSV Now
Phoenix, AZ
-
Vice President Global Medical Affairs - Rare Disease
Vice President Global Medical Affairs - Rare Disease
EPM Scientific
United States
-
Senior Medical Director (Tampa, FL)
Senior Medical Director (Tampa, FL)
VIPcare
Tampa, FL
-
Center Medical Director
Center Medical Director
Green Key Resources
Myrtle Beach, SC
-
Director of Clinical Education - Wound Care (Remote)
Director of Clinical Education - Wound Care (Remote)
Esperta Health
United States
-
Medical Director, Oscar Primary Care
Medical Director, Oscar Primary Care
Oscar Health
United States
-
Director, Medical Strategy
Director, Medical Strategy
OPEN Health
Parsippany, NJ
-
Inpatient Care Management Medical Director - Remote | WFH
Inpatient Care Management Medical Director - Remote | WFH
Get It Recruit - Healthcare
Minneapolis, MN
-
Medical Director
Medical Director
ClinicalMind
United States
-
Chief Medical Director
Chief Medical Director
Adecco
United States
-
Medical Director
Medical Director
Calcium+Company
Philadelphia, PA
-
Senior Medical Director, Utilization Management Operations
Senior Medical Director, Utilization Management Operations
Oscar Health
United States
-
Senior Medical Director
Senior Medical Director
Agenus
United States
-
Medical Director - Diagnostics/Alzheimers
Medical Director - Diagnostics/Alzheimers
Luminary Group
Massachusetts, United States
-
Medical Director
Medical Director
OncoHealth
United States
-
Vice President of Medical Affairs (Fully Remote)
Vice President of Medical Affairs (Fully Remote)
Medical Review Institute of America, LLC
Salt Lake City, UT
-
Senior Medical Director
Senior Medical Director
Warman O'Brien
United States
-
Medical Information Director
Medical Information Director
HireMinds
United States
-
Medical Director
Medical Director
RemeGen Biosciences
Pennsylvania, United States
-
Medical Director Informatics - Remote | WFH
Medical Director Informatics - Remote | WFH
Get It Recruit - Healthcare
Mishawaka, IN
-
Medical Director Informatics - Remote | WFH
Medical Director Informatics - Remote | WFH
Get It Recruit - Healthcare
Mishawaka, IN
-
Chief Medical Officer
Chief Medical Officer
Rehabwheel Inc.
United States
-
Medical Director
Medical Director
Pharma People
New Jersey, United States
-
Medical Director - Post Acute Care (Remote; Wed-Sun)
Medical Director - Post Acute Care (Remote; Wed-Sun)
CareCentrix
United States
-
Medical Director
Medical Director
RRxCo.™
United States
-
Medical Director
Medical Director
Synchrony Group, LLC
West Chester, PA
People also viewed
-
Director, Clinical Operations
Director, Clinical Operations
X4 Life Sciences
United States
-
Medical Director - West
Medical Director - West
CVS Health
California, United States
-
Senior Medical Director
Senior Medical Director
Proclinical Staffing
New York, NY
-
Chief Medical Officer/Owner
Chief Medical Officer/Owner
United States
-
Behavioral Medical Director - Remote | WFH
Behavioral Medical Director - Remote | WFH
Get It Recruit - Healthcare
Greensboro, NC
-
Medical Director - Diagnostics
Medical Director - Diagnostics
Luminary Group
Massachusetts, United States
-
Medical Director
Medical Director
The Jacobson Group
California, United States
-
Medical Director
Medical Director
Green Key Resources
United States
-
Director, Medical Research
Director, Medical Research
Intercept Pharmaceuticals
Morristown, NJ
-
Senior Medical Director
Senior Medical Director
RBW Consulting
United States
Looking for a job?
Visit the Career Advice Hub to see tips on interviewing and resume writing.
View Career Advice Hub