Medical Director (Spine/Ortho)

Job Description
Position Summary

**The Medical Director role is remote based, work from home**

Aetna, a CVS Health Company, has an exciting opportunity for 3 Medical Directors that can be remote based, work from home.  The Medical Directors will be Subject Matter Experts (SME) with a background in Orthopedic spine and Neurosurgery OR Orthopedic specialty, including post-graduate direct patient care experience specifically.  

Fundamental Components
Position Description

• Expands 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.
• Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities
• Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams
• Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise

Background Experience
Background/Experience

• 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 and Neurosurgery OR Orthopedic specialty including post-graduate direct patient care experience specifically.

Education
MD

Percent of Travel Required
0 - 10%