Medical Director – Aetna One Advocate

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Lead the management of utilization, which includes predetermination and UM reviews.

• Utilize clinical expertise to ensure accurate and consistent decision-making.

• Engage in the development, implementation, and assessment of clinical and medical programs.

• Enhance Aetna's medical management offerings throughout the continuum of care.

• Assist Medical Management staff in providing timely and consistent responses to both members and providers.

• Supervise utilization review and quality assurance initiatives.

• Direct efforts in case management.

• Offer clinical expertise and business guidance for medical management programs.

• Act as the primary clinical and business point of contact for network providers and facilities.

• Represent Aetna One Advocate during external presentations and plan sponsor meetings, approximately 15% of the time.

• Provide clinical oversight for the implementation of medical policies.

⛳️ Requirements

• An active, unrestricted MD is required.

• Must hold an M.D. or D.O.

• Board Certification in a specialty recognized by ABMS is necessary.

• Experience in direct patient care post-graduation is required.

• Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) is strongly preferred.

• Comfortable and experienced in presenting to external audiences.

• Excellent public speaking and stakeholder communication abilities.

• A collaborative mindset with the ability to work effectively in a close-knit, fast-paced clinical team.

• Prior experience in utilization management or managed care is not required; comprehensive training will be provided.

🏝️ Benefits

• Participation in CVS Health bonus, commission, or short-term incentive programs.

• Equity award programs available.

• Comprehensive medical coverage.

• Dental coverage provided.

• Vision coverage included.

• Paid time off is offered.

• Options for retirement savings.

• Access to wellness programs.

• Additional resources available to support physical, emotional, and financial well-being.