Medical Director (Aetna One Advocate)
Core
Lead clinical oversight for medical policy implementation and utilization management activities for a high-touch population health team.
Role type
Senior Medical Director (Utilization Management)
Builds
Medical management programs and utilization review processes for Aetna One Advocate members.
Domain
Health Insurance / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical expertise in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation; Utilization management decision-making; Case management leadership; External stakeholder engagement; Clinical program development
Preferred skills
Board certification in ABMS recognized specialties; Public speaking and presentation skills
Technologies
None stated
Responsibilities
Lead utilization management including predetermination and UM reviews; Apply clinical expertise to support accurate, consistent decisions; Participate in the development and evaluation of clinical/medical programs; Oversee utilization review and quality assurance activities; Direct case management efforts; Serve as lead clinical and business liaison to network providers and facilities; Represent the team in external-facing presentations and plan sponsor meetings
Seniority
Senior, hands-on IC with leadership responsibilities