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Medical Director – Aetna One Advocate
CVS Health. Lead utilization management, including predetermination and UM reviews .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates clinical expertise in utilization management and medical program development, with a focus on effective communication and collaboration within clinical teams and with external stakeholders.
Highest-signal resume keywords
Active, Unrestricted MDBoard Certification in ABMS SpecialtyClinical Oversight for Medical PolicyPublic Speaking SkillsUtilization Management Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ManagementClinical Program DevelopmentQuality Assurance ActivitiesCase ManagementMedical Policy Implementation
Soft Skills
Stakeholder CommunicationCollaborative MindsetPublic Speaking
Certifications & Qualifications
M.D. or D.O.Board Certification in NeurosurgeryBoard Certification in Orthopedic SurgeryBoard Certification in General SurgeryBoard Certification in Physical Medicine & Rehabilitation
Industry Keywords
Medical Management ProgramsUtilization ReviewClinical ExpertiseExternal PresentationsAetna One Advocate
About the role
Key responsibilities & impact- Lead utilization management, including predetermination and UM reviews
- Apply clinical expertise to support accurate, consistent decisions
- Participate in the development, implementation, and evaluation of clinical/medical programs
- Help expand Aetna's medical management programs across the continuum of care
- Support Medical Management staff in delivering timely, consistent responses to members and providers
- Oversee utilization review and quality assurance activities
- Direct case management efforts
- Provide clinical expertise and business direction for medical management programs through active participation in clinical team activities
- Serve as lead clinical and business liaison to network providers and facilities
- Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings, approximately 15% of the time
- Provide clinical oversight for medical policy implementation
Requirements
What you’ll need- Active, unrestricted MD required
- M.D. or D.O.
- Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience
- Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) strongly preferred
- Comfort and experience presenting to external audiences
- Strong public speaking and stakeholder communication skills
- Collaborative mindset and comfort working in a close, fast-moving clinical team
- No prior utilization management or managed care experience required; full training provided
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program
- Equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being