Orthopedic Spine Medical Director

6 days ago


Springfield, Illinois, United States CVS Health Full time
Job Summary

Aetna, a CVS Health Company, is seeking a Medical Director (Spine) to join our team. This is a remote-based position that can be worked from home anywhere in the US.

Key Responsibilities
  • Expand Aetna's medical management programs to address member needs across the continuum of care.
  • Support the Medical Management staff in ensuring timely and consistent responses to members and providers.
  • Lead all aspects of utilization review/quality assurance, directing 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 the effective execution of medical services programs by the clinical teams.
  • Predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
Requirements
  • 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 OR Neurosurgery, including post-graduate direct patient care experience specifically.
Preferred Qualifications
  • Previous healthcare insurance experience.
Education
  • 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 OR Neurosurgery, including post-graduate direct patient care experience specifically.
Compensation

The typical pay range for this role is $174,374,900.00. This 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 eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.



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