Job Description
Job Description
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
**This is a remote based (work from home) role and can be based anywhere in the US.**
In the Medical Director role you will provide oversight for medical policy implementation. You'll participate in the development, implementation, and evaluation of clinical/medical programs and expand Aetna's medical management programs to address member needs across the continuum of care You will support the Medical Management staff ensuring timely and consistent responses to members and providers. In addition you will oversee utilization review/quality assurance, directing case management In this role you'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities and act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams You'll be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise
Required 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 a recognized specialty including post-graduate direct patient care experience.
Preferred Qualifications
*Health plan/payor experience.
*Electronic medical systems/record experience
*Managed Care experience
Education
*Active and current state medical license without encumbrances
*M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
**This is a remote based (work from home) role and can be based anywhere in the US.**
In the Medical Director role you will provide oversight for medical policy implementation. You'll participate in the development, implementation, and evaluation of clinical/medical programs and expand Aetna's medical management programs to address member needs across the continuum of care You will support the Medical Management staff ensuring timely and consistent responses to members and providers. In addition you will oversee utilization review/quality assurance, directing case management In this role you'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities and act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams You'll be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise
Required 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 a recognized specialty including post-graduate direct patient care experience.
Preferred Qualifications
*Health plan/payor experience.
*Electronic medical systems/record experience
*Managed Care experience
Education
*Active and current state medical license without encumbrances
*M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
74006851