Sr Clinical Consultant

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Position Summary:
Aetna, a CVS Health company has an outstanding opportunity for a Prosthetist DME consultant. Ready to take your career to the next level with a Fortune 5 company?

This is a remote Work at Home position and can be located anywhere in the United States. 
 

In this role as Prosthetist DME consultant you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care, with a focus on clinical and payment policy. 

The Prosthetist DME consultant provides subject matter expertise to provide clinical support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. 
 

Responsibilities of the Prosthetist DME consultant include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the commercial, Medicare, and Medicaid environments. This Prosthetist DME consultant provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas. In this role you will: 
Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. 
Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices for commercial, Medicare, and Medicaid environments. 
Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality health care services.
Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant. 
Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. 
Work collaboratively with the functional areas.
 

Required Qualifications:
* American Board for Certification (ABC) certification in both Prosthetics and Orthotics

* 7-10 years clinical practice experience, e.g. hospital, professional practice.

* One year or more of health plan/payor experience.
* Current (or eligible) for at least one state license in prosthetics/orthotics

Preferred Qualifications:

• Managed care/claims review experience preferred

Education:
* B.A., B.S. or equivalent

Anticipated Weekly Hours

Time Type

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. 
 

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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