Medical Director – Medical Affairs, Oncology

Job not on LinkedIn

October 23

🥔 Idaho – Remote

Although this job is listed in Idaho, this company may be open to hiring remote in other states.

🌽 Illinois – Remote

Although this job is listed in Illinois, this company may be open to hiring remote in other states.

+3 more states

🥔 Idaho – Remote 🌽 Illinois – Remote 🦬 Montana – Remote 🌲 North Carolina – Remote 🎸 Mississippi – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CVS Health

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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.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Provide consultative clinical support to Account Management in support of Key Clients as assigned. • Transact Utilization Management (UM) activities (prior authorization and appeals) and respond to prescriber inquiries related to UM transactions and CVS Health coverage policies. • Model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. • Provide oversight of a portion of CVS Health's clinical programs and commercial client program support. • Share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. • Complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. • Participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. • Perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs.

🎯 Requirements

• Minimum of 5 years clinical experience in direct patient care. • Board Certified in Hematology/Oncology. • 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs. • Unrestricted license to practice medicine in the state in which the candidate is located. • Additional Board Certification in Internal Medicine is highly preferred. • Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as a teammate (e.g., RNs, PharmDs, etc.). • Master’s Degree in Public Health Administration, MBA, and/or UM/QA certification. • Proficiency in MS Office Suite, including Teams and Outlook.

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • 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.