[Hiring] Medical Director -Spine @CVS Health

Role Description

Aetna, a CVS Health Company, is hiring physicians that are board certified in Orthopedic Spine or Neurosurgery to expand Aetna's medical management program. This is an exciting opportunity to address member needs across the continuum of care and provide clinical expertise to the spine team.

• Responsible for precertification reviews of claim determinations
• Provide clinical, coding, and reimbursement expertise using multiple computer-based applications
• Remote position, work from home anywhere in the United States
• Subject Matter Expert (SME) with a background in Orthopedic Spine or Neurosurgery
• 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
• Acts as lead business and clinical liaison to network providers and facilities
• Responsible for predetermination reviews and reviews of claim determinations

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

Requirements

• Previous healthcare insurance experience (preferred)

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.

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation, and weight management programs
• Confidential counseling and financial coaching
• Paid time off, flexible work schedules, family leave, dependent care resources
• Colleague assistance programs, tuition assistance, retiree medical access