Medical Director

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

Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director. This is a remote Work at Home position and can be located anywhere in the United States.

As Medical Director MPO (Medical Policy & Operations), you will provide clinical expertise to promote the delivery of high-quality, constituent-focused medical care with a focus on clinical and payment policy.

Primary Responsibilities:

• Transactional reviews in support of the appeal process, clinical claim review process, and predetermination of covered benefits in Commercial and Medicare environments
• Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
• Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services
• Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services
• Be a subject matter expert, internal consultant, and payment policy contributor
• Demonstrate the ability to work within and lead teams comprised of a diverse group of health delivery professionals to manage business objectives
• Work collaboratively with functional areas

Required Qualifications:

• At least one year of experience employed within a health insurance company
• Five (5) 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 an ABMS-recognized specialty, including post-graduate direct patient care experience

Preferred Qualifications:

• Health plan/payor experience
• Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS/CPT, Clinical Policy, Reimbursement, and Health Care Systems
• Strong communication skills, both written and verbal

Pay Range:

$174,070.00 - $374,920.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors, including experience, education, geography, and other relevant factors.

Benefits:

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.