[Hiring] Medical Director @CVS Health

Role Description

Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home.

• The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.
• Expands Aetna's medical management programs to address member needs across the continuum of care.
• Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
• Leads all aspects of utilization review/quality assurance, directing case management.
• Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
• Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer-based applications.

Qualifications

• 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
• Active and current state medical license without encumbrances.
• M.D. or D.O., Board Certification in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.

Requirements

• Previous healthcare insurance experience (preferred).

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Pay Range

The typical pay range for this role is: $174,070.00 - $374,920.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.