Medical Director - (Ortho/Total Joint)

CVS Health; Hartford (CT); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading health solutions company is seeking a Medical Director specializing in Orthopedics. This remote role involves overseeing medical management programs and acting as a liaison to network providers. Ideal candidates will have significant clinical experience and a relevant medical license. Comprehensive benefits and a competitive salary range are offered.

Benefits

Comprehensive medical plans

401(k) with matching

Stock purchase plans

Wellness programs

Paid time off

Flexible schedules

Family leave

Qualifications

• 2+ years experience in Healthcare Delivery System and Clinical Practice.
• Active state medical license required.

Responsibilities

• Lead utilization review/quality assurance and direct case management.
• Provide clinical expertise and business direction for medical management.

Skills

Healthcare Delivery System

Clinical Practice

Medical Management

Education

M.D. or D.O., Board Certification in an Orthopedic specialty

Job description

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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Position Summary

Aetna, a CVS Health Company, a Fortune 6 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 at home) position anywhere in the US.

The Medical Director (Ortho/Total Joint) will be a Subject Matter Expert (SME) with a background in Orthopedic specialty, including post-graduate direct patient care experience. This role expands 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. You will lead all aspects of utilization review/quality assurance and direct case management. Additionally, you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. You will act as the lead business and clinical liaison to network providers and facilities to support effective execution of medical services programs by the clinical teams. You will also be responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

Required Qualifications

• 2 or more years of experience in Healthcare Delivery System, including Clinical Practice and Healthcare Industry
• Active and current state medical license without encumbrances
• M.D. or D.O., Board Certification in an Orthopedic specialty, including post-graduate direct patient care experience

Preferred Qualifications

• Previous healthcare insurance experience

Education

• M.D. or D.O., Board Certification in an Orthopedic specialty

Pay Range

The typical pay range for this role is $174,070.00 - $374,920.00. This range reflects base salary, and the actual offer will depend on experience, education, location, and other factors. The position is eligible for bonuses, incentives, and equity awards.

Benefits

We offer comprehensive benefits including medical plans, 401(k) with matching, stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, and more. For details, visit our benefits page.

Application deadline: 06/30/2025. Qualified applicants with arrest or conviction records will be considered as per law.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industries: Hospitals and Healthcare

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