Medical Director - Aetna One Advocate

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.

This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care.

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.

This is a remote based (work from home) role. Candidates can reside anywhere in the US.

The Medical Director (MD) for Aetna One Advocacy is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care.

The MD is a critical medical / business leader resource for external providers, plan sponsors, and regulatory agencies while working to achieve successful integration and effectiveness of the medical / care management programs.

The Medical Director that fills this position will be a part of Aetna One Advocacy which is a high touch and extremely collaborative program.

Aetna One Advocate is a dedicated team of clinical and service professionals empowered to take care of all aspects of a member’s health.

Medical directors on this team are responsible for overseeing and assisting in the plan’s personalized, end to end member experience.

The Aetna One Advocate model provides the member with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition.

Some key daily activities :

• Partner with other Advocate team members to holistically assess member’s needs
• Collaborate with treating providers through personalized, creative solutions to help member’s meet their health care needs.
• Lead the clinical staff in the coordination of quality care on behalf of members
• Conduct educational and clinical rounds with A1A clinical staff
• Provide clinical expertise and business direction in support of medical management and utilization review programs through participation in clinical team activities including precertification, concurrent review / discharge planning, case management, disease management and quality management
• Provide clinical guidance in promoting member quality of care and reviewing / addressing potential lapses
• Act to engage providers and facilities in improving the quality of care delivered to our members and assure that our shared relationships are maintained and improved
• Proactively use data analysis and periodic assessments to identify opportunities for quality improvement
• Work collaboratively with other functional areas that interface with medical management including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals

Required Qualifications :

• Full unrestricted MD or DO license
• Board Certification in an ABMS Specialty
• 5+ years clinical experience

Education : MD or DO

MD or DO

Pay Range

The typical pay range for this role is :

$174,070.00 - $374,900.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.

The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

This position also includes an award target in the company’s equity award program.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.