This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
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. Practice Spine Surgery....From Your Home! Aetna, a CVS Health Company, is hiring physicians that are board certified in Orthopedic Spine or Neurosurgery to expand Aetna's medical management program. This is an exciting opportunity to address member needs across the continuum of care and provide clinical expertise to the spine team. The medical directors are responsible for precertification reviews of claim determinations, and provide clinical, coding and reimbursement expertise using multiple computer based applications. This is a full time position, offering a salary with yearly raises, health insurance, 401K, stock plans and other benefits and an opportunity to use your skills but work regular hours in a remote position from anywhere in the United States
Job Responsibility:
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, using multiple computer based applications
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 a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically
Nice to have:
Previous healthcare insurance experience
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching