Medical Director (Ortho/Spine)
Aetna, a CVS Health Company, a Fortune 4 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 at home) based anywhere in the US.**
Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Ortho/Spine) that can be remote based, work from home. The Medical Director (Ortho/Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic spine and Neurosurgery OR Orthopedic specialty, including post-graduate direct patient care experience specifically. 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 ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise
- 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 Orthopedic spine and Neurosurgery OR Orthopedic specialty including post-graduate direct patient care experience specifically.
- Previous healthcare insurance experience
- Board Certified MD
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