Medical Director

This is a fully remote position, open to applicants in Pennsylvania, +1 more state.

📋 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 continuum of care.

• Assist Medical Management personnel by providing timely and consistent responses to both members and providers.

• Supervise utilization review and quality assurance processes.

• Perform predetermination reviews, which include Prior Authorization, Pre Certification, Concurrent Reviews, Peer to Peer Calls, First Level Appeals, Special Projects, and participation in Committees.

• Offer clinical expertise and direct case management as required.

• Deliver clinical insight and business guidance through involvement in clinical team activities.

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

• Facilitate the effective execution of medical services programs by clinical teams.

⛳️ Requirements

• M.D. or D.O. degree.

• Board Certification in an ABMS or AOA recognized specialty.

• Post-graduate experience in direct patient care.

• Active and valid state medical license.

• Preference for an active and current state medical license in either PA/WV/DE without any encumbrances.

• Prior experience in Utilization Management with a Health Plan/Payer is preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Target for awards in the company’s equity award program.

• Comprehensive benefits package that supports physical, emotional, and financial well-being.