Medical Director – Aetna One Advocate

This is a fully remote position, open to applicants in Alabama, +44 more states.

📋 Description

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

• Leverage clinical expertise to ensure precise and consistent decision-making.

• Engage in the design, execution, and assessment of clinical and medical programs.

• Assist in the growth of Aetna's medical management initiatives throughout the continuum of care.

• Aid Medical Management personnel in providing prompt and consistent responses to both members and providers.

• Supervise activities related to utilization review and quality assurance.

• Oversee case management operations.

• Offer clinical insights and strategic guidance for medical management programs by actively participating in clinical team initiatives.

• Act as the primary clinical and business liaison to network providers and facilities.

• Represent Aetna One Advocate in presentations and meetings with plan sponsors, dedicating approximately 15% of the time to this responsibility.

• Provide clinical oversight for the implementation of medical policies.

⛳️ Requirements

• Must possess an active, unrestricted MD.

• Hold either an M.D. or D.O. degree.

• Board certification in a specialty recognized by ABMS, along with post-graduate direct patient care experience.

• Preference for board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R).

• Experience and comfort in presenting to external audiences is essential.

• Strong skills in public speaking and communication with stakeholders.

• Ability to collaborate effectively and thrive in a close-knit, fast-paced clinical team.

• No previous experience in utilization management or managed care is necessary; comprehensive training will be provided.

🏝️ Benefits

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

• Opportunity for equity awards.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Options for retirement savings.

• Access to wellness programs.

• Additional resources that support physical, emotional, and financial wellness.