Medical Director (Cardiology)
About The Position
Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Cardiology) that can be remote based, work from home. This role can be remote based anywhere in the US. The Medical Director (Cardiology) will be a Subject Matter Expert (SME) with a background in Cardiology specialty, including post-graduate direct patient care experience specifically. This role expands Aetna's medical management programs to address member needs across the continuum of care. In this role you'll support the Medical Management staff ensuring timely and consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management. In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities You'll 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 In addition, you will be responsible for predetermination reviews ad 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 Cardiology specialty including post-graduate direct patient care experience specifically.
Nice To Haves
- Previous healthcare insurance experience.
Responsibilities
- Support the Medical Management staff 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.
- Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
