Experienced Medical Director for Aetna One Advocacy - Transforming Healthcare through Clinical Expertise and Business Leadership

Bringing Our Heart to Every Moment of Your Health At CVS Health, we're driven by a singular purpose: to make healthcare more personal, convenient, and affordable. Our commitment to delivering enhanced human-centric health care is guided by our Heart At Work Behaviors, which empower every member of our team to transform our culture and accelerate innovation. As part of Aetna, a CVS Health Company, we're leveraging our experience as one of the oldest and largest national insurers to help shape the future of healthcare. About Aetna One Advocacy Aetna One Advocacy is a high-touch, collaborative program dedicated to providing personalized, end-to-end experiences for our members. As a Medical Director for Aetna One Advocacy, you'll be part of a team that's passionate about delivering exceptional care and support to our members. Our model is built around proactive, high-touch communications designed to help members achieve their health ambitions. Job Summary We're seeking an experienced Medical Director to provide clinical expertise and business direction in support of our medical management programs. As a critical medical and business leader, you'll work closely with external providers, plan sponsors, and regulatory agencies to drive the successful integration and effectiveness of our medical and care management programs. This remote-based role offers the flexibility to work from anywhere in the US. Key Responsibilities Partner with Advocate team members to holistically assess member needs and develop personalized solutions. Collaborate with treating providers to help members meet their healthcare needs through creative, tailored approaches. Lead clinical staff in coordinating quality care on behalf of members, ensuring seamless delivery of services. Conduct educational and clinical rounds with A1A clinical staff to drive knowledge sharing and best practices. Provide clinical expertise and business direction in support of medical management and utilization review programs. Participate in clinical team activities, including precertification, concurrent review/discharge planning, case management, disease management, and quality management. Offer clinical guidance to promote member quality of care and address potential lapses. Engage providers and facilities in improving the quality of care delivered to our members, fostering strong relationships. Proactively analyze data to identify opportunities for quality improvement and implement changes. Collaborate with other functional areas, including provider relations, sales, benefits, healthcare delivery, national medical services, and national accounts, to achieve business goals. Qualifications and Requirements To be successful in this role, you'll need: A full, unrestricted MD or DO license. Board Certification in an ABMS Specialty. At least 5 years of clinical experience. An MD or DO degree from an accredited institution. Preferred Qualifications While not required, the following qualifications can enhance your candidacy: Experience in medical management, utilization review, or a related field. Strong understanding of healthcare operations, including provider relations and network management. Excellent communication and interpersonal skills, with the ability to work effectively with diverse stakeholders. A passion for delivering high-quality, patient-centered care. Skills and Competencies To excel as a Medical Director for Aetna One Advocacy, you'll need: Clinical expertise: A strong foundation in clinical medicine, with the ability to apply this knowledge in a variety of contexts. Business acumen: The ability to drive business decisions and strategy, leveraging data and insights to inform your approach. Leadership skills: The capacity to lead and motivate clinical staff, fostering a culture of excellence and collaboration. Communication and interpersonal skills: Excellent written and verbal communication skills, with the ability to work effectively with diverse stakeholders, including providers, plan sponsors, and regulatory agencies. Career Growth Opportunities and Learning Benefits At CVS Health, we're committed to helping our colleagues grow and develop in their careers. As a Medical Director for Aetna One Advocacy, you'll have access to: Ongoing training and development opportunities, designed to enhance your clinical and business skills. A collaborative, supportive work environment that encourages knowledge sharing and innovation. Opportunities to work on high-impact projects and initiatives, driving meaningful change in the healthcare industry. Work Environment and Company Culture As a remote-based role, you'll enjoy the flexibility to work from anywhere in the US. Our company culture is built around our Heart At Work Behaviors, which prioritize: Empathy and compassion: We're committed to delivering care and support that's personal, convenient, and affordable. Innovation and collaboration: We encourage our colleagues to think creatively and work together to drive innovation. Inclusion and diversity: We value diverse perspectives and experiences, fostering an inclusive work environment that supports our colleagues' growth and success. Compensation, Perks, and Benefits We offer a comprehensive compensation package, including: A competitive base salary, with a pay range of $174,070 - $374,900. Eligibility for a CVS Health bonus, commission, or short-term incentive program. Award targets in our company's equity award program. A full range of medical, dental, and vision benefits. A 401(k) retirement savings plan and Employee Stock Purchase Plan. Term life insurance, short-term and long-term disability benefits. Numerous well-being programs, education assistance, and free development courses. A CVS store discount and discount programs with participating partners. Paid Time Off (PTO) and paid holidays throughout the calendar year. Join Our Team If you're a dedicated, compassionate healthcare professional looking to make a meaningful impact, we encourage you to apply for this exciting opportunity. As a Medical Director for Aetna One Advocacy, you'll be part of a team that's passionate about delivering exceptional care and support to our members. Together, we can transform the healthcare industry and make a lasting difference in the lives of our members. Apply Job! Apply to this Job Apply for this job