Medical Director -Spine

Overview

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. This experience supports our mission to transform health care toward a more transparent and consumer-focused system that recognizes physicians for clinical quality and efficient use of health care resources.

Practice Spine Surgery from your home. Aetna, a CVS Health Company, is hiring physicians who are board certified in Orthopedic Spine or Neurosurgery to expand Aetna’s medical management program. This is a full-time position offering a salary with yearly raises, health insurance, 401K, stock plans and other benefits, with regular hours in a remote position from anywhere in the United States.

Remote-based (work at home) from anywhere in the US. Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based.

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.

Expands Aetna’s medical management programs to address member needs across the continuum of care and supports the Medical Management staff ensuring timely and consistent responses to members and providers. Leads all aspects of utilization review / quality assurance and directs case management. Provides clinical 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 using multiple computer-based applications.

• Expand Aetna’s medical management programs to address member needs across the continuum of care.
• Support Medical Management staff ensuring timely and consistent responses to members and providers.
• Lead all aspects of utilization review and quality assurance; direct case management.
• Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• Act as lead business and clinical liaison to network providers and facilities to support effective execution of medical services programs by clinical teams.
• Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding and reimbursement expertise using multiple computer-based applications.

• 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 Orthopedic Spine or Neurosurgery, including post-graduate direct patient care experience specifically.

• Previous healthcare insurance 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 Orthopedic Spine or Neurosurgery, including post-graduate direct patient care experience.

The typical pay range for this role is:

$ - $

The pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is…