Medical Director

• 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

Medical Director – Aetna One Advocate

• 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