Remote Based Medical Director- ENT

Full-Time Remote | Work from Home | Anywhere in the U.S.

At Aetna, a CVS Health company, we're helping transform healthcare by making it more transparent, consumer-focused, and driven by quality outcomes. As one of the nation's largest and most established health insurers, we are committed to improving the healthcare experience for our members, providers, and communities.

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About the Role

Aetna is seeking an experienced Medical Director specializing in Otolaryngology (ENT) to join our Medical Management team. This is a fully remote opportunity that allows you to work from anywhere in the United States.

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In this role, you will serve as a clinical subject matter expert, providing guidance and oversight for medical management programs while supporting quality, consistency, and evidence-based decision-making across the continuum of care.

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Key Responsibilities

• Serve as the clinical Subject Matter Expert (SME) for Otolaryngology (ENT).
• Conduct utilization management and medical necessity reviews.
• Support timely and consistent clinical determinations for members and providers.
• Review prior authorizations, predeterminations, and claim determinations.
• Provide clinical expertise related to coding, reimbursement, and medical policy.
• Partner with case management and utilization management teams to support quality patient care.
• Participate in clinical discussions and interdisciplinary team activities.
• Act as a clinical liaison with network physicians, provider groups, and healthcare facilities.
• Contribute to the development and enhancement of medical management programs and initiatives.
• Have post-residency direct patient care experience in Otolaryngology.
• Strong clinical expertise and understanding of evidence-based medicine.
• Experience with utilization management, medical policy review, or health plan operations is preferred.
• Excellent communication and collaboration skills.

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 Otolaryngology, including post-graduate direct patient care experience specifically.

Preferred Qualifications Previous UM experience with a Health Plan / Payor.

Education MD or DO