Medical Director - Pain Management

Medical Director (Pain Management)

Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Pain Management) that can be remote based, work from home.

The Medical Director, Pain Management serves as a Subject Matter Expert (SME) with specialized training and post-graduate direct patient care experience in pain management. This role supports the expansion and execution of medical management programs designed to address member needs across the continuum of care.

In this role you will:

• Provide clinical leadership and expertise to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers.
• Lead utilization management and quality assurance activities, including oversight of medical necessity reviews and case management initiatives.
• Support medical management programs through active participation in interdisciplinary clinical team activities and strategic decision-making.
• Serve as the primary clinical and business liaison to network providers and healthcare facilities, fostering collaboration and supporting the effective implementation of medical services programs.
• Conduct predetermination reviews and claim determination reviews, applying clinical judgment and expertise in medical coding, reimbursement, and coverage policies.
• Provide guidance and consultation on complex clinical cases, helping ensure quality outcomes and regulatory compliance.
• Support the development and continuous improvement of medical management strategies, policies, and processes.

• Post-graduate direct patient care experience in pain management.
• Demonstrated expertise in utilization management, case management, quality improvement, and clinical review processes.
• Strong knowledge of medical coding, reimbursement methodologies, and healthcare regulations.
• Excellent communication, collaboration, and leadership skills with the ability to engage effectively with providers, clinical teams, and business stakeholders.

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 Pain Management specialty including post-graduate direct patient care experience specifically

Preferred Qualifications:

• Previous healthcare insurance experience.

Education:

• M.D. or D.O., Board Certification in a Pain Management specialty.

Pay Range: $ - $

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.