Medical Director

• Provide oversight for medical policy implementation
• Participate in the development, implementation, and evaluation of clinical and medical programs
• Expand Aetna's medical management programs to address member needs across the continuum of care
• Support Medical Management staff in providing timely and consistent responses to members and providers
• Oversee utilization review and quality assurance
• Conduct predetermination reviews and review claim determinations
• Perform prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, and first-level appeals
• Participate in special projects and committees as needed
• Provide clinical, coding, and reimbursement expertise
• Direct case management when necessary
• Provide clinical expertise and business direction for medical management programs through clinical team activities
• Serve as lead business and clinical liaison to network providers and facilities

Explore Medical Director at CVS Health Careers. Review requirements and application details.