CVS Health Medical Director in Indianapolis, Indiana
Aetna, a CVS Health Company has an exciting opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 5 company?
This role is a remote based (work from home) opportunity. We ideally would like the candidate to reside in : MI, IN, IL, MN or WI.
As a Medical Director (MD) you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical and business leader and contact for external providers, plan sponsor, and regulatory agencies and participates in the strategic medical management for our plan sponsors. The Medical Director will partner with medical management to increase effectiveness of medical management programs and promote integration of other Aetna medical programs.
Full or Part Time:
Percent of Travel Required:
0 - 10%
Posting Job Title:
Potential Telework Position:
IL-Chicago, IL-Moline, IN-Indianapolis, MI-Detroit, MN-Minneapolis, WI-Waukesha
Primary Location (City, State):
Aetna is an Equal Opportunity, Affirmative Action Employer
In this role you will:
Execute predetermination reviews, reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
Manage UM transactional work (front line reviews and appeals).
Build and inspire a culture of continuous improvement for better quality of care.
Oversee utilization review/quality assurance directing case management.
Provide UM services based on business demands and shifting business needs
Lead the clinical staff in the coordination of quality care on behalf of members utilizing their available benefits.
Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities (e.g. telephonic rounds) in the execution of precertification, concurrent review/discharge planning, case management, disease management, appeals, pharmacy review and quality management.
Provide clinical guidance in operating effective medical programs to promote member quality of care and in reviewing potential lapses in the quality of care.
Proactively use data analysis to identify opportunities for overall value improvement (including both financial as well as quality improvement), to positively influence the effective delivery of quality care.
Mentor employees and supports ongoing training and development of clinical staff and acts in a manner consistent with the Aetna Way.
Work collaboratively with other functional areas that interface with medical management within the National Account Care Management Solutions Team including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals of the company.
Act as critical medical leader for external providers, plan sponsors, regulatory & accrediting agencies, and community in general.
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 recognized specialty including post-graduate direct patient care experience.
Benefit eligibility may vary by position.
Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Clinical Licensure Required:
Board Certified MD
- CVS Health Jobs