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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