Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
As a Medical Director on the Aetna One Advocate team, you'll help shape the execution of a multidisciplinary model to guide members toward their best possible health care outcomes.
Responsibilities
- Lead utilization management, including predetermination and UM reviews
- Apply clinical expertise to support accurate, consistent decisions
- Participate in the development, implementation, and evaluation of clinical/medical programs
- Help expand Aetna's medical management programs to better address member needs across the continuum of care
- Support Medical Management staff in delivering timely, consistent responses to members and providers
- Oversee utilization review and quality assurance activities
- Direct case management efforts
- Provide clinical expertise and business direction for medical management programs through active participation in clinical team activities
- Serve as lead clinical and business liaison to network providers and facilities, supporting effective execution of medical services programs
- Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings (approx. 15% of time)
Requirements
- Active, unrestricted MD required
- Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) strongly preferred
- No prior utilization management or managed care experience required , full training provided
- Comfort and experience presenting to external audiences , strong public speaking and stakeholder communication skills
- Collaborative mindset and comfort working in a close, fast-moving clinical team
Benefits
- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources
Pay Range
- $174,070.00 - $374,920.00