Job Title

Job DescriptionFully remote role with standard business hours,8am-5pm Monday-Friday.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 4 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 and Medicare environment. 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: â—¾Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. â—¾Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests. â—¾Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services.â—¾ Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant. â—¾Demonstrate 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. â—¾Work Collaboratively with the functional areas.Pay RangeThe typical pay range for this role is:Minimum: 55,300Maximum: 118,900Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- ABC certification and license () in both prosthetics and orthotics - 5+ years clinical practice experience, e.g. hospital, professional practice.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Managed care/claims review experience- 1+ year of health plan/payor experience- Strong computer skillsEducation-Minimum of Bachelor's Degree requiredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.