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About the Role

We are building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience. Join us to help simplify health care one person, one family, and one community at a time.

Responsibilities

• Participate in the development, implementation, and evaluation of clinical/medical programs.
• Expand Aetna's medical management programs to address member needs across the continuum of care.
• Support Medical Management staff, ensuring timely and consistent responses to members and providers.
• Handle Prior Authorization/Pre-Certification/Concurrent Reviews/Peer to Peer calls/First Level Appeals/Special Projects and Committee participation.
• Provide clinical expertise and business direction in support of medical management programs.
• Act as lead business and clinical liaison to network providers and facilities.

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 recognized specialty including post-graduate direct patient care experience.

Skills

• Electronic medical systems/record experience
• Managed Care experience

Location

• United States

Work Type

• Full-time
• Remote

Experience Level

• 2 or more years of experience in Health Care Delivery System
• Five or more years of direct patient care experience

Education Level

• M.D. or D.O.
• Board Certification in a recognized specialty
• Board certification in Internal Medicine, Family Medicine, Emergency Medicine, or General Surgery or other surgery specialties.

Salary/Compensations

• $174,070.00 - $374,920.00
• Eligible for CVS Health bonus, commission or short-term incentive program
• Includes an award target in the company’s equity award program

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs

About the Company

• Aetna, a CVS Health Company, is one of the oldest and largest national insurers.
• We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
• Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Equal Opportunity

• Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.