Medical Director (Aetna One Advocate)
About The Position
Aetna One Advocate (A1A) is a high-touch, population health medical management team built around collaboration, advocacy, and case-by-case resolution for our members. We're a tight-knit team of clinicians who use a multidisciplinary model to guide members toward their best possible health care outcomes. We pride ourselves on being innovative and nimble, adapting our approach to what each member actually needs rather than applying one-size-fits-all solutions. As a Medical Director on this team of 8 physicians, you'll help shape how that model is executed clinically and operationally, while being part of a close collaborative culture. You'll provide clinical oversight for medical policy implementation and lead utilization management activities. Including predetermination reviews, Utilization management determinations and case management. This role also blends clinical leadership with external engagement: you'll spend roughly 15% of your time presenting to and meeting with our plan sponsors.
Requirements
- Active, unrestricted MD required
- Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) strongly preferred
- No prior utilization management or managed care experience required — full training provided
- Comfort and experience presenting to external audiences — strong public speaking and stakeholder communication skills
- Collaborative mindset and comfort working in a close, fast-moving clinical team
- M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience
Responsibilities
- Lead utilization management, including predetermination and UM reviews
- Apply clinical expertise to support accurate, consistent decisions
- Participate in the development, implementation, and evaluation of clinical/medical programs
- Help expand Aetna's medical management programs to better 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 (approx. 15% of time)
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
