Medical Director (Aetna One Advocate)

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.

Position Summary

Aetna One Advocate (A1A) is a high-touch, population health medical management team built around collaboration, advocacy, and case-by-case resolution for our members. We're a tight-knit team of clinicians who use a multidisciplinary model to guide members toward their best possible health care outcomes. We pride ourselves on being innovative and nimble, adapting our approach to what each member actually needs rather than applying one-size-fits-all solutions.

As a Medical Director on this team of 8 physicians, you'll help shape how that model is executed clinically and operationally, while being part of a close collaborative culture.

You'll provide clinical oversight for medical policy implementation and lead utilization management activities. Including predetermination reviews, Utilization management determinations and case management. This role also blends clinical leadership with external engagement: you'll spend roughly 15% of your time presenting to and meeting with our plan sponsors.

What You'll Do

• Lead utilization management, including predetermination and UM reviews
• Apply clinical expertise to support accurate, consistent decisions
• Participate in the development, implementation, and evaluation of clinical/medical programs
• Help expand Aetna's medical management programs to better address member needs across the continuum of care
• Support Medical Management staff in delivering timely, consistent responses to members and providers
• Oversee utilization review and q