Job Description
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
**This is a remote based (work from home) role and can be based anywhere in the US.**
Aetna Medicaid is looking for a Medical Director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia. The Medical Director is a work-at-home position supporting the Aetna Medicaid line of business in these sixteen states, offering a variety of physical and behavioral health programs and services to its membership.
Required Qualifications
- 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and current state medical license without encumbrances
- M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience
COVID Vaccine Required :
Yes
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications
- Health plan/payor experience.
- Electronic medical systems/record experience
- Managed Care experience
Education
- Active and current state medical license without encumbrances
- M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience