Medical Director - ENT

Job Title: Medical Director - ENT 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. 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 discussion