Medical Director - ENT

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Job Description Summary

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.

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.

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.

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.

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

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

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.