Medical Director – Commercial

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

📋 Description

• Engage in the development, execution, and assessment of clinical/medical initiatives.

• Enhance Aetna's medical management programs to meet member needs throughout the continuum of care.

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

• Carry out Prior Authorization, Pre-Certification, Concurrent Reviews, Peer to Peer consultations, First Level Appeals, special projects, and committee involvement as necessary.

• Offer clinical insight and business guidance through active participation in clinical team endeavors.

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

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

⛳️ Requirements

• A minimum of 2 years of experience in the Health Care Delivery System, such as Clinical Practice and the Health Care Industry.

• Possession of an active and current state medical license without any encumbrances.

• An M.D. or D.O. degree.

• Board Certification in a recognized medical specialty.

• Post-graduate experience in direct patient care.

• Preferred: Five or more years of direct patient care experience.

• Preferred: Previous experience in Utilization Management with a health plan or payor.

• Preferred: Experience with electronic medical systems/records.

• Preferred: Managed Care experience.

• Preferred: Board certification in Internal Medicine, Family Medicine, Emergency Medicine, or General Surgery.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Equity award program.