Medical Director – Commercial

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Participate in the development, implementation, and evaluation of clinical/medical programs • Expand Aetna's medical management programs to address member needs across the continuum of care • Support Medical Management staff by ensuring timely and consistent responses to members and providers • Conduct Prior Authorization, Pre-Certification, Concurrent Reviews, Peer to Peer calls, First Level Appeals, special projects, and committee participation as needed • Provide clinical expertise and business direction through participation in clinical team activities • Act as lead business and clinical liaison to network providers and facilities • Support effective execution of medical services programs by clinical teams

🎯 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 a recognized specialty • Post-graduate direct patient care experience • Five or more years of direct patient care experience preferred • Previous UM experience with a Health plan/payor experience preferred • Electronic medical systems/record experience preferred • Managed Care experience preferred • Board certification in Internal Medicine, Family Medicine, Emergency Medicine, or General Surgery preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • CVS Health bonus, commission or short-term incentive program • Equity award program