Medical Director (Medical Policy Ops-DRG)

Job Title: Medical Director (Medical Policy Ops-DRG) Job Location: Work at Home, Connecticut, United States Job Location Type: Remote Job Contract Type: Full time Job Seniority Level: 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, a CVS Health company, has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company? This is a remote Work at Home position and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy & Operations) you will be responsible for providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. The Primary Responsibilities of this Medical Director role include transactional reviews in support of the appeal process, clinical claim review process, and predetermination of covered benefits in the Commercial and Medicare environments. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is p