Medical Director – SWAT

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

📋 Description

• Oversee the implementation of medical policies.

• Engage in the creation, 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 in delivering prompt and consistent responses to both members and providers.

• Supervise utilization review processes and quality assurance.

• Manage case management activities.

• Offer clinical expertise and strategic direction for medical management programs.

• Participate in activities with clinical teams.

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

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

• Conduct predetermination evaluations and assessments of claim determinations.

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

⛳️ Requirements

• Minimum of 2 years of experience within a healthcare delivery system, such as clinical practice or the healthcare sector.

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

• Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree.

• Board certification in a recognized specialty, accompanied by post-graduate direct patient care experience.

• Board certification in a recognized ABMS or AOA specialty, including post-graduate direct patient care experience.

• Experience in health plan/payor settings is preferred.

• Familiarity with electronic medical systems and records is desirable.

• Managed Care experience is preferred.

🏝️ Benefits

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

• Award target within the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that support physical, emotional, and financial well-being, depending on eligibility.