Medical Director -Spine

CVS Health•Washington, NV

9d•$174,070 - $374,920•Remote

About The Position

CVS Health/Aetna is hiring a remote Medical Director specializing in spine care, based anywhere in the United States. The role serves as a subject matter expert with an Orthopedic Spine or Neurosurgery background, including postgraduate direct patient-care experience. The Medical Director expands medical management programs across the continuum of care and provides clinical expertise and business direction to support those programs. Responsibilities include supporting medical management staff, leading utilization review and quality assurance, directing case management, serving as a clinical and business liaison to network providers and facilities, and conducting predetermination reviews and reviews of claim determinations using clinical, coding, and reimbursement expertise and computer-based applications. The role requires an M.D. or D.O., board certification in Orthopedic Spine or Neurosurgery, a current, unrestricted state medical license, and at least two years of experience in a healthcare delivery system or the healthcare industry. Previous healthcare insurance experience is preferred. The position is full-time and remote. The stated base pay range is $174,070 to $374,920, with eligibility for a CVS Health bonus, commission, or short-term incentive program and an equity award target. The benefits package includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

At least 2 years of experience in a healthcare delivery system, such as clinical practice, or in the healthcare industry.
Active and current state medical license without encumbrances.
M.D. or D.O. degree.
Board certification in Orthopedic Spine or Neurosurgery.
Postgraduate direct patient-care experience, specifically.

Nice To Haves

Previous healthcare insurance experience.

Responsibilities

Expand Aetna medical management programs to address member needs across the continuum of care.
Support Medical Management staff to ensure timely and consistent responses to members and providers.
Lead utilization review and quality assurance, and direct case management.
Provide clinical expertise and business direction for medical management programs through participation in clinical team activities.
Act as lead business and clinical liaison to network providers and facilities to support execution of medical services programs by clinical teams.
Conduct predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise using computer-based applications.