Medical Director (Spine/Ortho)

Aetna Inc. Culver City , CA 90231

Posted 2 weeks ago

Job Description:

Position Summary

The Medical Director role is remote based, work from home

Aetna, a CVS Health Company, has an exciting opportunity for 3 Medical Directors that can be remote based, work from home. The Medical Directors will be Subject Matter Experts (SME) with a background in Orthopedic spine and Neurosurgery OR Orthopedic specialty, including post-graduate direct patient care experience specifically.

Fundamental Components

Position Description

  • 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

Background Experience

Background/Experience

  • 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.

Education

MD

Percent of Travel Required

0 - 10%

Business Overview

Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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Medical Director (Spine/Ortho)

Aetna Inc.