Medical Director -Spine

Position Summary

Aetna, a CVS Health Company, is hiring physicians to expand its medical management program. This role involves working remotely from anywhere in the United States to provide clinical expertise and support the spine team.

Responsibilities

• Precertification reviews of claim determinations
• Provide clinical, coding, and reimbursement expertise using multiple computer based applications
• Support the Medical Management staff ensuring timely and consistent responses to members and providers
• Lead all aspects of utilization review/quality assurance, directing case management
• Act as lead business and clinical liaison to network providers and facilities
• Responsible for predetermination reviews and reviews of claim determinations

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

Qualifications

• Previous healthcare insurance experience preferred

Skills

Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.

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.

Pay

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.