Medical Director -Spine

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

** This is a fully remote, work-from-home position that may be performed from anywhere within the United States. **

Aetna, a CVS Health company and one of the nation's largest health benefits providers, is seeking a Medical Director, Spine to support and expand its medical management programs. This is a unique opportunity for a board-certified physician in Orthopedic Spine Surgery or Neurosurgery to leverage their clinical expertise in a remote, work-from-home environment while helping improve healthcare outcomes across the continuum of care.

The Medical Director will serve as a clinical leader and subject matter expert, providing guidance on medical necessity determinations, utilization management, quality initiatives, and complex clinical reviews. This role offers the opportunity to apply specialized spine expertise while maintaining a predictable schedule and work-life balance.

In this role you will:

• Serve as the primary Subject Matter Expert (SME) for spine-related clinical reviews and medical management activities.
• Support and expand Aetna's medical management programs to address member needs across the continuum of care.
• Provide clinical consultation and direction to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers.
• Lead and support utilization management, quality assurance, and case management activities.
• Participate in interdisciplinary clinical team meetings and initiatives, providing clinical expertise and business guidance.
• Act as the primary clinical and business liaison to network providers, facilities, and other healthcare stakeholders.
• Conduct precertification and predetermination reviews, as well as reviews of claim determinations.
• Apply clinical expertise to evaluate medical necessity, appropriateness of care, coding accuracy, and reimbursement considerations.
• Utilize multiple technology platforms and computer-based applications to support review and decision-making processes.
• Promote quality, efficiency, and consistency in medical management practices and outcomes.

• Significant post-graduate direct patient care experience in spine surgery.
• Demonstrated expertise in utilization management, clinical review, and evidence-based medicine.
• Strong understanding of healthcare delivery systems, medical necessity criteria, coding, and reimbursement practices.
• Excellent communication, collaboration, and leadership skills.
• Ability to effectively manage responsibilities in a remote work environment.

The position offers a minimum base salary of $250,000. With the potential for annual bonus and Long-Term Incentive (LTI).

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 a 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 a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience.

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. 
 

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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