CVS Health
This role provides clinical expertise and business direction in support of Aetna's medical management programs, with a focus on spine-related precertification reviews, claim determinations, and utilization review/quality assurance. The position also serves as a liaison to network providers and facilities and supports timely, consistent responses to members and providers using multiple computer-based applications.
Key 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.
- • Be responsible for predetermination reviews and reviews of claim determinations.
- • Provide clinical, coding, and reimbursement expertise using multiple computer based applications.
Required
- • 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
- • Previous healthcare insurance experience.
Benefits & Perks
- • Salary with yearly raises
- • Health insurance
- • 401K
- • Stock plans
- • Other benefits
- • Opportunity to use your skills but work regular hours in a remote position from anywhere in the United States
- • Eligible for a CVS Health bonus, commission or short-term incentive program
- • Award target in the company’s equity award program
- • Comprehensive benefits package
- • Medical, dental, and vision coverage
- • Paid time off
- • Retirement savings options
- • Wellness programs
- • Other resources, based on eligibility
Position Summary
Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
Practice Spine Surgery....From Your Home! Aetna, a CVS Health Company, is hiring physicians that are board certified in Orthopedic Spine or Neurosurgery to expand Aetna's medical management program. This is an exciting opportunity to address member needs across the continuum of care and provide clinical expertise to the spine team. The medical directors are responsible for precertification reviews of claim determinations, and provide clinical, coding and reimbursement expertise using multiple computer based applications. This is a full time position, offering a salary with yearly raises, health insurance, 401K, stock plans and other benefits and an opportunity to use your skills but work regular hours in a remote position from anywhere in the United States
**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.
The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.
Expands Aetna's medical management programs to address member needs across the continuum of care.
Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
Acts 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 ad 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 a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.
- Previous healthcare insurance experience.
- 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.
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.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 07/31/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Keep track of your job search
Save personal notes for each job to track your thoughts, application status, and follow-ups.
Try for freeUpload your resume
Sign up to upload your resume and get AI-powered customization for job applications.
Sign up freePractice your interview
Get AI-powered mock interviews tailored to this Medical Director -Spine role. Upload your resume and practice with real-time voice feedback.
Sign up to practice