Medical Director

We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.

This is a remote-based (work from home) position. Ideal candidates will reside in Midlands States (IL, MO, MN, WI) and have a medical license without encumbrances in one of these states.

Job Summary: As a Medical Director at Aetna, a CVS Health Company, you will provide oversight for medical policy implementation, participate in developing, implementing, and evaluating clinical/medical programs, and expand Aetna's medical management programs.

Key Responsibilities:

• 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 utilisation review and quality assurance, focusing on predetermination reviews and review of claim determinations
• Conduct prior authorisation/pre-certification/concurrent reviews, peer-to-peer calls, first-level appeals, and special projects
• Provide clinical, coding, and reimbursement expertise, directing case management when necessary
• Offer clinical expertise and business direction in support of medical management programs
• Act as a lead business and clinical liaison to network providers and facilities

Requirements:

• Five (5) or more years of experience in Healthcare Delivery System (e.g., Clinical Practice and Healthcare Industry)
• Active and current medical license without encumbrances
• M.D. or D.O., active and current board certification in an ABMS or AOA-recognised specialty, including post-graduate direct patient care experience

Preferred Qualifications:

• Previous UM experience with a Health Plan/Payor/Physician Advisor in a Healthcare system
• Board certification in Internal Medicine, Family Medicine, Emergency Medicine, or Med/Peds/General Surgery

Education: Medical Doctor or Doctor of Osteopathic Medicine

Pay Range: $174,070.00 - $374,920.00

Benefits: Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.