Medical Director

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

📋 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 reviews and quality assurance processes.

• Conduct predetermination assessments and evaluations of claims decisions.

• Execute prior authorization, pre-certification, concurrent evaluations, peer-to-peer discussions, and initial appeals.

• Join special projects and committees as required.

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

• Lead case management when needed.

• Provide clinical knowledge and strategic direction for medical management programs through activities of the clinical team.

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

⛳️ Requirements

• A minimum of five (5) years of experience in the Health Care Delivery System, including Clinical Practice and the Health Care Industry.

• A valid and current state medical license without any encumbrances (Florida preferred).

• M.D. or D.O. degree.

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

• Direct patient care experience post-graduation.

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

• Must be eligible for licensure anywhere in the United States.

🏝️ Benefits

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

• Award target in the company's equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that support physical, emotional, and financial well-being, based on eligibility.