Medical Director – Spine

Role Overview

• Subject Matter Expert (SME) with background in Orthopedic Spine OR Neurosurgery
• 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 effective execution of medical services programs
• Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer based applications

Requirements

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

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility