Medical Director – Aetna One Advocate

Job not on LinkedIn

🔥 1 minute ago

🏈 Alabama, Alaska, +43 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead utilization management, including predetermination and UM reviews • Apply clinical expertise to support accurate, consistent decisions • Participate in the development, implementation, and evaluation of clinical/medical programs • Help expand Aetna's medical management programs across the continuum of care • Support Medical Management staff in delivering timely, consistent responses to members and providers • Oversee utilization review and quality assurance activities • Direct case management efforts • Provide clinical expertise and business direction for medical management programs through active participation in clinical team activities • Serve as lead clinical and business liaison to network providers and facilities • Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings, approximately 15% of the time • Provide clinical oversight for medical policy implementation

🎯 Requirements

• Active, unrestricted MD required • M.D. or D.O. • Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience • Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) strongly preferred • Comfort and experience presenting to external audiences • Strong public speaking and stakeholder communication skills • Collaborative mindset and comfort working in a close, fast-moving clinical team • No prior utilization management or managed care experience required; full training provided

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being