Medical Director - ENT
About The Position
Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (ENT) that can be remote based, work from home. The Medical Director (ENT) will be a Subject Matter Expert (SME) with a background in Otolaryngology, including post-graduate direct patient care experience specifically. 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
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 Otolaryngology, including post-graduate direct patient care experience specifically.
Nice To Haves
- Previous UM experience with a Health Plan / Payor.
Responsibilities
- 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.
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
Manager
Education Level
Ph.D. or professional degree
