Description
CVS Health's Aetna division is seeking a remote-based Medical Director specializing in Pain Management. This role involves providing clinical leadership, overseeing utilization management and quality assurance, leading interdisciplinary clinical team activities, serving as a liaison to healthcare providers, conducting predetermination and claim determination reviews, guiding complex clinical cases, and supporting strategy development. The ideal candidate will have extensive post-graduate direct patient care experience in pain management, strong expertise in utilization management, case management, quality improvement, and clinical review processes, along with solid knowledge of medical coding, reimbursement methodologies, and healthcare regulations.
