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 the diverse needs of members throughout the care continuum.

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

• Supervise utilization reviews and quality assurance processes.

• Conduct predetermination reviews and evaluate claim decisions.

• Execute Prior Authorization, Pre Certification, Concurrent Reviews, Peer to Peer Calls, First Level Appeals, and participate in special projects and committees as necessary.

• Provide expertise in clinical practices, coding, and reimbursement.

• Direct case management as required.

• Offer clinical knowledge and business guidance to support medical management programs.

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

⛳️ Requirements

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

• Possess an active and current medical license without restrictions in one of the Midland States (IL, MO, MN, WI).

• Hold an M.D. or D.O. degree.

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

• Have post-graduate experience in direct patient care.

• Preferred experience in Utilization Management with a Health Plan, Payor, 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.

• Award target within the company’s 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.