Medical Director -Spine

CVS Health

9d•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Aetna, a CVS Health Company, is hiring physicians that are board certified in Orthopedic Spine or Neurosurgery to expand Aetna's medical management program. This is an exciting opportunity to address member needs across the continuum of care and provide clinical expertise to the spine team. The medical directors are responsible for precertification reviews of claim determinations, and provide clinical, coding and reimbursement expertise using multiple computer based applications. This is a remote based (work at home) based anywhere in the US. Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, 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, using multiple computer based applications.

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.

Nice To Haves

Previous healthcare insurance experience.

Responsibilities

Provide clinical expertise to the spine team.
Responsible for precertification reviews of claim determinations.
Provide clinical, coding and reimbursement expertise using multiple computer based applications.
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, using multiple computer based applications.