CVS Health
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 – Ortho/Total Joint
Job not on LinkedIn
November 19
🦬 Montana – Remote
🌲 North Carolina – Remote
+2 more states
💵 $174.1k - $374.9k / year
⏰ Full Time
🔴 Lead
👨⚕️ Medical Director
CVS Health
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
• Lead all aspects of utilization review/quality assurance, directing case management • Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities • Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams • Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise
🎯 Requirements
• 2 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 Orthopedic specialty including post-graduate direct patient care experience specifically • Previous healthcare insurance experience.
🏖️ 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 • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access
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