Medical Director

This role supports the Aetna Better Health of West Virginia primarily, and the Southeast Region (FL, KY and LA). The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. Responsible for Utilization Management, including prior authorization and pre certification as well as concurrent review. Cases could focus on inpatient or outpatient, acute and post-acute as well as peer to peer calls and first level appeals.