Medical Director

This is a fully remote position, open to applicants in Connecticut, +6 more states.

📋 Description

• Supervise utilization review processes for healthcare systems located in the New England Region.

• Conduct and manage utilization reviews and quality assessments for inpatient hospital stays, prior authorizations, and appeals.

• Engage in the creation, 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 timely and consistent responses to both members and providers.

• Manage Prior Authorizations, Pre Certifications, Concurrent Reviews, Peer to Peer Calls, First Level Appeals, Special Projects, and Committee involvement as necessary.

• Acquire knowledge of the New England market, including hospitals, outpatient networks, and value-based care partnerships.

⛳️ Requirements

• A minimum of two (2) years of experience in the Health Care Delivery System, such as Clinical Practice and the Health Care Industry.

• An active and current medical license free of encumbrances.

• M.D. or D.O. degree.

• Active and current Board Certification in a specialty recognized by ABMS or AOA.

• Direct patient care experience obtained post-graduation.

• Proficiency with technology, including Microsoft Outlook and Teams.

• Capability to secure a medical license in a New England state within a reasonable period, if not already licensed.

• Prior experience in Utilization Management (UM) with a Health Plan or Payor is preferred.

• Previous experience as a Physician Advisor in a Health or Hospital system is preferred.

• Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine is preferred.

🏝️ Benefits

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

• Award target through the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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