Medical Director

This is a fully remote position, open to applicants in Iowa.

📋 Description

• Oversee the implementation of medical policies.

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

• Enhance Aetna's medical management initiatives to meet member needs throughout the care continuum.

• Assist Medical Management personnel in delivering prompt and consistent responses to both members and providers.

• Supervise utilization review and quality assurance activities.

• Carry out predetermination reviews and evaluate claims decisions.

• Execute prior authorization, pre-certification, concurrent reviews, peer-to-peer discussions, and first-level appeals.

• Take part in special projects and committees as required.

• Offer expertise in clinical matters, coding, and reimbursement.

• Lead case management when needed.

• Supply clinical insights and business guidance for medical management programs via clinical team efforts.

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

⛳️ Requirements

• Minimum of five (5) years of experience in a healthcare delivery setting, including clinical practice and the healthcare industry.

• An active and unencumbered medical license.

• M.D. or D.O. degree.

• Current board certification in a specialty recognized by ABMS or AOA.

• Direct patient care experience post-graduation.

• Preferred: Prior experience in utilization management with a health plan/payer or as a physician advisor within a healthcare system.

• Preferred: Board certification in Internal Medicine, Family Medicine, Emergency Medicine, Med/Peds, or General Surgery.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Equity award program.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness initiatives.

• Additional resources promoting physical, emotional, and financial well-being.