CVS Health
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.
Medical Director – Medical Policy & Operations
Job not on LinkedIn
🕒 May 9
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CVS Health
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
• providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy • transactional reviews in support of the appeal process, clinical claim review process, and predetermination of covered benefits in the Medicare and commercial environments, with emphasis on Medicare clinical and payment policy • 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 to service and payment requests • proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services • be a subject matter expert, internal consultant and payment policy contributor • work collaboratively with the functional areas
🎯 Requirements
• Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. • Active and current state medical license without encumbrances. • M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience
🏖️ Benefits
• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility
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