Sr Clinical Consultant - Prosthetist DME

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.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/orthoticsPreferred Qualifications:

• Managed care/claims review experience preferredEducation:
* B.A., B.S. or equivalent Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$88,374.00 - $190,344.00This 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 peopleWe 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.