Medical Director – Aetna One Advocate

Job Description:

  • Lead utilization management, including predetermination and UM reviews
  • Apply clinical expertise to support accurate, consistent decisions
  • Participate in developing, implementing, and evaluating clinical/medical programs
  • Expand Aetna's medical management programs 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
  • Serve as lead clinical and business liaison to network providers and facilities
  • Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings, approximately 15% of the time
  • Provide clinical oversight for medical policy implementation

Requirements:

  • Active, unrestricted MD required
  • M.D. or D.O.
  • Board Certification in an ABMS recognized specialty
  • Post-graduate direct patient care experience
  • Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) strongly preferred
  • 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
  • No prior utilization management or managed care experience required; full training provided

Benefits:

  • CVS Health bonus, commission or short-term incentive program
  • Equity award program
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being
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