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Position Summary

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. 

There will be some weekend and holiday call required as part of the New England Team. This will be scheduled well in advance and all of the Medical Directors will be a part of the rotation.

This is a remote based (work from home) position for the New England Region. The preferred candidate will reside in Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Massachusetts or Maine.

The Medical Director will be responsible for overseeing the utilization review for health systems and providers in New England. An ideal candidate would have experience performing in-hospital utilization reviews and other quality activities. The Medical Director will be required to have a New England state medical license without encumbrances, or the ability to obtain the license within a reasonable timeframe.   

  

Collaboration and teamwork are the defining characteristics of The New England Medical Director team; in order to be a successful member of the team the candidate must exemplify these qualities.   

• As a Medical Director you will focus primarily on overseeing utilization review and quality assurance of inpatient hospitalizations, prior authorizations, and appeals.
• 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. 

Required Qualifications:

*Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.

*Active and current medical license without encumbrances

*M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.

Preferred Qualifications:

*Residence in one of the states in the New England Region

*Previous UM experience with a Health Plan / Payor.

*Previous UM experience as a Physician Advisor in a Health / Hospital system. 

*Board Certification in Internal Medicine, Family Medicine,  or Emergency Medicine Preferred.

Education:
*Medical Doctor or Doctor of Osteopathic Medicine

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,920.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/29/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.