CVS Health is hiring a Medical Director - (Ortho/Total Joint) to serve as a Subject Matter Expert within our Aetna organization. With a background in Orthopedic specialty and direct patient care, you will expand medical management programs to address member needs across the continuum of care.
What You'll Do
- Support Medical Management staff ensuring timely and consistent responses to members and providers.
- Lead all aspects of utilization review and quality assurance, directing case management.
- Provide clinical expertise and business direction for medical management programs through participation in clinical team activities.
- Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs.
- Be responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
What We're Looking For
- 2 or more years of experience in a 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. with Board Certification in an Orthopedic specialty, including post-graduate direct patient care experience.
Nice to Have
- Previous healthcare insurance experience.
Benefits & Compensation
- Compensation range: $174,070.00 - $374,920.00.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation, weight management, confidential counseling and financial coaching.
- Paid time off, flexible work schedules, family leave, dependent care resources, tuition assistance, retiree medical access and many other benefits depending on eligibility.
Work Mode
This is a remote position open to candidates located in the US.
CVS Health is committed to fostering a workplace where every colleague feels valued and that they belong. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
