Medical Director - ENT

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.

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.

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.

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.

• →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.

The position offers a minimum base salary of $250,000. With the potential for annual bonus and Long-Term Incentive (LTI).

* 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

The typical pay range for this role is: