Medical Director (Aetna One Advocate)
About The Position
Aetna One Advocate (A1A) is a high-touch population health medical management team focused on collaboration, advocacy, and case-by-case resolution for members. The Medical Director joins a team of eight physicians and helps shape the clinical and operational execution of this multidisciplinary model, which adapts care to individual member needs. The role provides clinical oversight for medical policy implementation and leads utilization management activities, including predetermination reviews, utilization management determinations, and case management. It also includes clinical leadership and external engagement, with approximately 15% of time spent presenting to and meeting with plan sponsors. This is a fully remote position, with availability primarily during Pacific Time business hours preferred (8:00 a.m. to 5:00 p.m. PT). No prior utilization management or managed care experience is required; full training is provided. The position requires an active, unrestricted MD. The education section also specifies an M.D. or D.O., board certification in an ABMS-recognized specialty, and postgraduate direct patient care experience.
Requirements
- Active, unrestricted MD required.
- M.D. or D.O., board certification in an ABMS-recognized specialty, and postgraduate direct patient care experience.
- Comfort and experience presenting to external audiences, with strong public speaking and stakeholder communication skills.
- Collaborative mindset and comfort working in a close, fast-moving clinical team.
- Availability primarily during Pacific Time business hours is preferred.
Nice To Haves
- Board certification or eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) is strongly preferred.
Responsibilities
- Lead utilization management, including predetermination and utilization management reviews.
- Apply clinical expertise to support accurate, consistent decisions.
- Participate in the development, implementation, and evaluation of clinical and medical programs.
- Help expand Aetna's medical management programs to address member needs across the continuum of care.
- Support Medical Management staff in delivering timely, consistent responses to members and providers.
- Oversee utilization review and quality assurance activities.
- Direct case management efforts.
- Provide clinical expertise and business direction for medical management programs through active participation in clinical team activities.
- Serve as lead clinical and business liaison to network providers and facilities, supporting effective execution of medical services programs.
- Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- CVS Health bonus, commission, or short-term incentive program eligibility
- Eligibility for an award target in the company equity award program
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
