Description: ??Provide oversight for medical policy implementation ??Participate in the development, implementation, and evaluation of clinical / medical programs ??Expand Aetna's medical management programs to address member needs across the continuum of care ??Support the Medical Management staff ensuring timely and consistent responses to members and providers ??Oversee utilization review / quality assurance and be responsible for predetermination reviews ??Provide clinical expertise as well as directing case management when necessary ??Provide clinical expertise and business direction in support of medical management programs ??Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Requirements: ??Active and current state medical license without encumbrances ??M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience ??Previous UM experience with a Health Plan / Payor (Preferred) ??Board Certification in Internal Medicine, Family Medicine, Surgery Specialty (Preferred) Benefits: ??Affordable medical plan options ??401(k) plan (including matching company contributions) ??Employee stock purchase plan ??No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching ??Paid time off ??Flexible work schedules ??Family leave ??Dependent care resources ??Colleague assistance programs ??Tuition assistance ??Retiree medical access ??Many other benefits depending on eligibility