Medical Director

This is a fully remote position, open to applicants in Illinois, +3 more states.

📋 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 requirements across the care continuum.

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

• Supervise utilization review and quality assurance processes.

• Conduct predetermination reviews and evaluate claim decisions.

• Execute Prior Authorization, Pre Certification, Concurrent Reviews, Peer to Peer Calls, and First Level Appeals.

• Contribute to special projects and committees as necessary.

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

• Lead case management when required.

• Supply clinical knowledge and business guidance through involvement in clinical team activities.

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

⛳️ Requirements

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

• Possession of an active and current medical license without restrictions.

• Must hold an M.D. or D.O. degree.

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

• Direct patient care experience following postgraduate education.

• Preferred candidates should reside in IL, MO, MN, or WI.

• Prior experience in Utilization Management with a Health Plan / Payor / Physician Advisor in a Healthcare system is desirable.

• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, Med / Peds, or General Surgery is preferred.

🏝️ 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 to support physical, emotional, and financial well-being.