Medical Director - (Ortho / Total Joint)

Medical Director - (Ortho / Total Joint)

CVS Health

Position Summary

As the nation’s leading health solutions company, we are building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a remote based (work at home) position based anywhere in the US.

The Medical Director (Ortho / Total Joint) will be a Subject Matter Expert (SME) with a background in Orthopedic specialty, including post-graduate direct patient care experience specifically. This role expands Aetna's medical management programs to address member needs across the continuum of care. In this role you’ll support the Medical Management staff ensuring timely and consistent responses to members and providers. You will lead all aspects of utilization review / quality assurance, directing case management. You will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. You’ll 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. In addition, you will be responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

Required Qualifications

• 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 an Orthopedic specialty with post-graduate direct patient care experience specifically.

Preferred Qualifications

Education

Pay Range

$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.

Great Benefits For Great People

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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