Medical Director – Aetna One Advocate
Job Description:
- Lead utilization management, including predetermination and UM reviews
- Apply clinical expertise to support accurate, consistent decisions
- Participate in developing, implementing, and evaluating clinical/medical programs
- Expand Aetna's medical management programs across the continuum of care
- Support Medical Management staff in delivering timely, consistent responses to members and providers
- Oversee utilization review and quality assurance activities
- Direct case management efforts
- Provide clinical expertise and business direction for medical management programs
- Serve as lead clinical and business liaison to network providers and facilities
- Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings, approximately 15% of the time
- Provide clinical oversight for medical policy implementation
Requirements:
- Active, unrestricted MD required
- M.D. or D.O.
- Board Certification in an ABMS recognized specialty
- Post-graduate direct patient care experience
- Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) strongly preferred
- Comfort and experience presenting to external audiences
- Strong public speaking and stakeholder communication skills
- Collaborative mindset and comfort working in a close, fast-moving clinical team
- No prior utilization management or managed care experience required; full training provided
Benefits:
- CVS Health bonus, commission or short-term incentive program
- Equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
