Medical Director - Pain Management

CVS Health•Work At Home-Connecticut, CT

1d•$174,070 - $374,920•Remote

About The Position

Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Pain Management) that can be remote based, work from home. This role can be remote based anywhere in the US. The Medical Director, Pain Management serves as a Subject Matter Expert (SME) with specialized training and post-graduate direct patient care experience in pain management. This role supports the expansion and execution of medical management programs designed to address member needs across the continuum of care.

Requirements

M.D. or D.O., Board Certification in a Pain Management specialty.
Post-graduate direct patient care experience in pain management.
Demonstrated expertise in utilization management, case management, quality improvement, and clinical review processes.
Strong knowledge of medical coding, reimbursement methodologies, and healthcare regulations.
Excellent communication, collaboration, and leadership skills with the ability to engage effectively with providers, clinical teams, and business stakeholders.
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.

Nice To Haves

Previous healthcare insurance experience.

Responsibilities

Provide clinical leadership and expertise to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers.
Lead utilization management and quality assurance activities, including oversight of medical necessity reviews and case management initiatives.
Support medical management programs through active participation in interdisciplinary clinical team activities and strategic decision-making.
Serve as the primary clinical and business liaison to network providers and healthcare facilities, fostering collaboration and supporting the effective implementation of medical services programs.
Conduct predetermination reviews and claim determination reviews, applying clinical judgment and expertise in medical coding, reimbursement, and coverage policies.
Provide guidance and consultation on complex clinical cases, helping ensure quality outcomes and regulatory compliance.
Support the development and continuous improvement of medical management strategies, policies, and processes.