FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
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 with network providers and stakeholders. Holds an active MD or DO with board certification in a recognized specialty, ensuring high-quality oversight in medical management.
Highest-signal resume keywords
Active, Unrestricted MDBoard Certification in ABMS SpecialtyPost-Graduate Direct Patient Care ExperiencePublic Speaking SkillsClinical Program Development
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
Strong Communication SkillsCollaborative Mindset
Certifications & Qualifications
M.D.D.O.Board Certification in NeurosurgeryBoard Certification in Orthopedic SurgeryBoard Certification in General SurgeryBoard Certification in Physical Medicine & Rehabilitation
Industry Keywords
Utilization ManagementClinical ExpertiseMedical Management ProgramsQuality Assurance ActivitiesCase ManagementStakeholder Communication
About the role
Key responsibilities & impact- Lead utilization management, including predetermination and UM reviews
- Apply clinical expertise to support accurate, consistent decisions
- Participate in developing, implementing, and evaluating clinical/medical programs
- 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
- 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
- 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