Medical Director (IlliniCare Aetna Medicaid)
This position is a "Work at Home" fully remote work arrangement. The Medical Director will support the IlliniCare Pan and Aetna owned Medicaid business serving members in the state of Illinois. The dedication of talented and caring health care professionals drives the delivery of high quality cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge. Provide support and oversight of our Medicaid clinical programs which are designed to improve population health, drive quality outcomes, and deliver culturally competent services through an integrated delivery system. Perform utilization management reviews, peer to peer consultations, medical necessity appeals, and lead clinical rounds. Support the development and evaluation of clinical programs. Supports Aetna Medicaid's medical management programs across the continuum of care. Supports other clinical staff ensuring timely and consistent responses to members and providers. Provides clinical expertise in support of medical management programs through participation in clinical team activities.