CVS Health - Medical Director (Ortho/Total Joint) - Charleston, West Virginia
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Position Summary
Aetna, a CVS Health Company, is looking for a Medical Director (Ortho/Total Joint) who will be a Subject Matter Expert (SME) with a background in Orthopedic specialty. This role expands Aetna's medical management programs to address member needs across the continuum of care.
Key Responsibilities
- Support Medical Management staff ensuring timely and consistent responses to members and providers.
- Lead all aspects of utilization review/quality assurance, directing case management.
- Provide clinical expertise and business direction in support of medical management programs.
- Act as lead business and clinical liaison to network providers and facilities.
- Responsible for predetermination reviews and reviews of claim determinations.
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 including post-graduate direct patient care experience.
Preferred Qualifications
- Previous healthcare insurance experience.
Pay Range
The typical pay range for this role is: $174,070.00 - $374,920.00. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Benefits
The Company offers a full range of medical, dental, and vision benefits, 401(k) retirement savings plan, Employee Stock Purchase Plan, fully-paid term life insurance, short-term and long-term disability benefits, and numerous well-being programs.
We anticipate the application window for this opening will close on: 10/28/2024.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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