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 Ops, DRG
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 • predetermination of covered benefits in the Commercial and Medicare environments • participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve 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
🎯 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
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