Medical Director - Pain Management

About the role

Aetna, a CVS Health Company, is seeking a Medical Director (Pain Management) to join their team. This role can be remote based, working from home anywhere in the US. The Medical Director, Pain Management will provide clinical leadership and expertise to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers.

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.
• 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.

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 Pain Management specialty including post-graduate direct patient care experience specifically.

Preferred Qualifications

• Previous healthcare insurance experience.

Qualifications

• M.D. or D.O., Board Certification in a Pain Management specialty.

Benefits

The typical pay range for this role is $174,070.00 - $374,920.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.