Medical Director - Spine

American College of Health Care Administrators; Hartford (CT); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading healthcare provider seeks a Medical Director (Spine) to oversee utilization review and manage clinical activities from a remote setting. The ideal candidate will possess board certification in Orthopedic Spine or Neurosurgery, showcasing their expertise in healthcare delivery systems. This role demands strong leadership in clinical management to enhance patient care and streamline processes.

Benefits

Comprehensive benefits package

401(k) with matching

Tuition assistance

Paid time off

Flexible schedules

Qualifications

• 2+ years experience in Healthcare Delivery System required.
• Requires active medical license without encumbrances.
• Board Certification in Orthopedic Spine or Neurosurgery necessary.

Responsibilities

• Lead utilization review and direct case management activities.
• Serve as clinical liaison to network providers.
• Conduct predetermination reviews and ensure quality assurance.

Skills

Clinical Practice

Healthcare Management

Utilization Review

Quality Assurance

Clinical Expertise

Education

M.D. or D.O. with Board Certification

Active Medical License

Job description

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 available anywhere in the US.

Aetna has an exciting opportunity for a Medical Director (Spine) that can be remote-based, working from home.

The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.

This role expands Aetna's medical management programs to address member needs across the continuum of care and supports the Medical Management staff in ensuring timely and consistent responses to members and providers.

Responsibilities include leading all aspects of utilization review/quality assurance, directing case management, and providing clinical expertise in support of medical management programs through participation in clinical team activities.

The Medical Director acts as the lead business and clinical liaison to network providers and facilities to support effective execution of medical services programs by clinical teams. They are responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer-based applications.

Required Qualifications

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

Preferred Qualifications

• Previous healthcare insurance experience.

Education

• Same as required qualifications, emphasizing the need for experience in healthcare delivery and active medical license.

Pay Range

The typical pay range for this role is $174,070.00 - $374,920.00. This range represents the base salary or hourly rate for positions within this job grade. The actual offer will depend on experience, education, geography, and other factors. The role is eligible for bonuses, commissions, or short-term incentives, and includes an equity award target.

Benefits

We offer a comprehensive benefits package including medical plans, 401(k) with matching, stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, retiree medical access, and more.

For more information, visit https://jobs.cvshealth.com/us/en/benefits.

The application window closes on 07/18/2025.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.