# Medical Director

**Company**: Aetna, a CVS Health Company
**Location**: Work from home, IL
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $174,070.00 - $374,920.00
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/IL---Work-from-home/Medical-Director---Midland-States_R1095013?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/medical-director-c88ab02d-901/

## Description

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.

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## Skills

### Required
- medical license
- M.D. or D.O.
- board certification
- clinical practice
- healthcare industry

### Nice to have
- UM experience
- Internal Medicine
- Family Medicine
- Emergency Medicine
- Med/Peds/General Surgery

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/IL---Work-from-home/Medical-Director---Midland-States_R1095013?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)