Responsibilities

The Medical Director (Spine) will serve as a Subject Matter Expert (SME) providing clinical expertise and business direction to support medical management programs, participating in clinical team activities, and leading all aspects of utilization review/quality assurance. They will also conduct predetermination reviews and claim determinations, offering clinical, coding, and reimbursement expertise, and acting as a lead business and clinical liaison to network providers and facilities to ensure effective execution of medical services programs. Furthermore, the Medical Director will support the Medical Management staff by providing timely and consistent responses to members and providers, expanding Aetna’s medical management programs to address member needs across the continuum of care.