Job Description

Position Summary At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. This is a remote based (work at home) based anywhere in the US. Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. Responsibilities Expand Aetna's medical management programs to address member needs across the continuum of care. Support the Medical Management staff ensuring timely and consistent responses to members and providers. Lead all aspects of utilization review / quality assurance, directing case management. Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Act 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 and reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer based applications. Required Qualifications 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 Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically. Preferred Qualifications Previous healthcare insurance experience. Education 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 Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically. Pay Range The typical pay range for this role is : 174,070.00 - $374,920.00 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. Benefits 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. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include : 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. Additional Information For more information, visit We anticipate the application window for this opening will close on: 07 / 18 / 2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health

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