Medical Director - Commercial

Description: • Provide oversight for medical policy implementation • Participate in the development, implementation, and evaluation of clinical / medical programs • Expand Aetna's medical management programs to address member needs across the continuum of care • Support the Medical Management staff ensuring timely and consistent responses to members and providers • Oversee utilization review / quality assurance and be responsible for predetermination reviews • Provide clinical expertise as well as directing case management when necessary • Provide clinical expertise and business direction in support of medical management programs • Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Requirements: • Active and current state medical license without encumbrances • M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience • Previous UM experience with a Health Plan / Payor (Preferred) • Board Certification in Internal Medicine, Family Medicine, Surgery Specialty (Preferred) Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access • Many other benefits depending on eligibility Apply Job!