Medical Director

This is a fully remote position, open to applicants in Pennsylvania, +2 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 needs throughout the care continuum.

• Assist Medical Management personnel in delivering timely and consistent responses to both members and providers.

• Supervise utilization review and ensure quality assurance.

• Perform predetermination assessments, including prior authorization, pre-certification, concurrent reviews, peer-to-peer consultations, and first-level appeals.

• Contribute to special projects and committees as required.

• Offer clinical expertise and direct case management when needed.

• Support medical management initiatives through the activities of the clinical team.

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

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

⛳️ Requirements

• M.D. or D.O. degree required.

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

• Experience in direct patient care after postgraduate training.

• Must possess an active and current state medical license.

• Preference for an active and current state medical license in PA, WV, or DE with no encumbrances.

• Previous experience in Utilization Management with a Health Plan/Payor is preferred.

🏝️ Benefits

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

• Eligibility for the company's equity award program.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off benefits.

• Retirement savings options available.

• Wellness programs offered.

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