• Provide oversight for medical policy implementation as part of a team dedicated to the Federal Employee Health Benefits Program (FEHBP). • 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, case management, disease management, benefit planning, and fraud investigation. • Provide clinical expertise and business direction in support of medical and pharmacy management programs. • Act as a lead business and clinical liaison to network providers and facilities, plan sponsors, and related vendors. • Support the effective execution of medical services programs by the clinical teams. • Responsible for precertification reviews, appeals, and reviews of claim determinations, providing clinical expertise and judgement.