Medical Director - ENT
Description:
- Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (ENT) that can be remote based, work from home.
- The Medical Director (ENT) will be a Subject Matter Expert (SME) with a background in Otolaryngology, including post-graduate direct patient care experience specifically.
- 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.
Requirements:
- 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 Otolaryngology, including post-graduate direct patient care experience specifically.
- Previous UM experience with a Health Plan / Payor.
Benefits:
- Affordable medical plan options,
- a 401(k) plan (including matching company contributions),
- and an employee stock purchase plan .
- No-cost programs for all colleagues including wellness screenings,
- tobacco cessation and weight management programs,
- confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off,
- flexible work schedules,
- family leave,
- dependent care resources,
- colleague assistance programs,
- tuition assistance,
- retiree medical access and many other benefits depending on eligibility.
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