Medical Director – Aetna Duals Center of Excellence

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🔥 18 hours ago

🌽 Illinois, Oklahoma, +2 more states – Remote

🌽 Illinois – Remote 🌪️ Oklahoma – Remote 🎸 Mississippi – Remote 🤠 Texas – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials. • The medical director will perform appeals in their “base plans” and may round robin based on “same or similar specialty” needs. • The medical director will perform pharmacy reviews. • The medical director will participate in and be able to lead rounds.

🎯 Requirements

• Minimum 3-5 years of clinical practice experience • Two (2) + years of experience in managed care (Medicare and/or Medicaid) • Experience with managed care (Medicare and Medicaid) utilization review preferred • MD or DO; Board certification in an ABMS or AOA recognized specialty is required • Active and current state medical license without encumbrances is required • Multiple state licensure a plus

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support physical, emotional, and financial well-being of colleagues and their families