Medical Director – Pain Management

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🔥 1 minute ago

🦌 Connecticut – Remote

🦌 Connecticut – 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

• Provide clinical leadership and expertise to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers. • Lead utilization management and quality assurance activities, including oversight of medical necessity reviews and case management initiatives. • Support medical management programs through active participation in interdisciplinary clinical team activities and strategic decision-making. • Serve as the primary clinical and business liaison to network providers and healthcare facilities, fostering collaboration and supporting the effective implementation of medical services programs. • Conduct predetermination reviews and claim determination reviews, applying clinical judgment and expertise in medical coding, reimbursement, and coverage policies. • Provide guidance and consultation on complex clinical cases, helping ensure quality outcomes and regulatory compliance. • Support the development and continuous improvement of medical management strategies, policies, and processes.

🎯 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 Pain Management specialty including post-graduate direct patient care experience specifically

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package