Medical Director

• 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 and reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer-based applications

• 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 Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically

previous healthcare insurance experience

• affordable medical plan options
• a 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
• paid time off
• flexible work schedules
• family leave
• dependent care resources
• colleague assistance programs
• tuition assistance
• retiree medical access