Medical Director - ENT

Description: • Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (ENT) that can be remote based, work from home. • The Medical Director (ENT) will be a Subject Matter Expert (SME) with a background in Otolaryngology, including post-graduate direct patient care experience specifically. • 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 the effective execution of medical services programs by the clinical teams • Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. 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 Otolaryngology, including post-graduate direct patient care experience specifically. • Previous UM experience with a Health Plan / Payor. Benefits: • Affordable medical plan options, • a 401(k) plan (including matching company contributions), • and an employee stock purchase plan . • No-cost programs for all colleagues including wellness screenings, • tobacco cessation and weight management programs, • confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, • flexible work schedules, • family leave, • dependent care resources, • colleague assistance programs, • tuition assistance, • retiree medical access and many other benefits depending on eligibility. Apply Job!