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Job DescriptionReady to take your Medical Director skill set to the next level with a Fortune 5 company? Check out this opportunity with Aetna, a CVS Health Company.In this role as a Medical Director you will provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs.This is a remote based, work from home role.In the Medical Director role you will Expand Aetna's medical management programs to address member needs across the continuum of care Supports the Medical Management staff ensuring timely and consistent responses to members and providers. You will Oversee utilization review/quality assurance, directing case management You'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities The Medical Director will act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams You will also be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertiseRequired Qualifications2 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 encumbrancesM.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.Preferred QualificationsPlease review required qualifications aboveEducationMDBusiness OverviewAt CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
