Medical Director - Mid West Region
HumanaSalary not specified
- Full Time
- Junior (1 to 2 years)
$174,070 – $374,920Compensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
Health SolutionsIndustries
Position Overview
- Location Type: Remote (Work at Home)
- Employment Type: Full Time
- Salary: $174,070.00 - $374,920.00
Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. This is a remote-based opportunity available anywhere in the US. 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.
Requirements
- Experience: 2 or more years of experience in Health Care Delivery System (e.g., Clinical Practice and Health Care Industry).
- Licensure: Active and current state medical license without encumbrances.
- Education: M.D. or D.O.
- Board Certification: Board Certification in Orthopedic Spine or Neurosurgery, including post-graduate direct patient care experience.
Responsibilities
- 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.
Preferred Qualifications
- Previous healthcare insurance experience.
Company Information
- Company: Aetna, a CVS Health Company
- Industry: Health Solutions
- Size: Fortune 6 Company
- Mission: To transform health care and reach millions of Americans through local presence, digital channels, and more than 300,000 colleagues.
Skills
Orthopedic Spine
Neurosurgery
Clinical Practice
Health Care Delivery
Utilization Review
Quality Assurance
Case Management
Coding
Reimbursement
Medical Management
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees