Medical Director - Commercial

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Aetna, a CVS Health 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 from home) role and can be based anywhere in the US.**

• You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.

• You will support the Medical Management staff ensuring timely and consistent responses to members and providers.

• This includes Prior Authorization/Pre-Certification/Concurrent Reviews/Peer to Peer calls/First Level Appeals/Special Projects and Committee participation when needed.

• You will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.

• 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.

*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.

*Five or more years of direct patient care experience

*Previous UM experience with a Health plan/payor experience.
*Electronic medical systems/record experience
*Managed Care experience

*Board certification in Internal Medicine, Family Medicine, Emergency Medicine, or General Surgery.

*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

The typical pay range for this role is: