Medical Director - Spine

CVS Health; South Dakota; On-site; USD 200,000 - 300,000; Full time

Job summary

An established industry player is seeking a Medical Director specializing in Spine to join their remote team. This role offers a unique opportunity to leverage your expertise in Orthopedic Spine or Neurosurgery to transform healthcare delivery. As a Subject Matter Expert, you will lead initiatives in medical management, ensuring high-quality patient care while collaborating with network providers. Your contributions will directly impact clinical quality and resource utilization, making a significant difference in the lives of patients. If you're passionate about improving healthcare and have a strong clinical background, this is the opportunity for you.

Qualifications

• Must have post-graduate direct patient care experience.
• Experience in medical management programs is essential.

Responsibilities

• Expand medical management programs and support staff.
• Lead utilization review and quality assurance efforts.

Skills

Orthopedic Spine expertise

Neurosurgery knowledge

Clinical quality assessment

Utilization review

Coding expertise

Reimbursement knowledge

Education

Medical Degree (MD or DO)

Board certification in Orthopedic Surgery or Neurosurgery

Job description

Position Summary

Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. It offers a unique opportunity to help transform health care by promoting transparency and consumer focus, recognizing physicians for their clinical quality and effective resource use.

This is a remote-based (work at home) position anywhere in the US.

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. The role involves expanding Aetna's medical management programs, supporting Medical Management staff, leading utilization review and quality assurance, and acting as a clinical liaison to network providers and facilities. Responsibilities also include predetermination reviews and claim determinations, providing clinical, coding, and reimbursement expertise.