Medical Director – ENT

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🔥 0 minutes ago

🦌 Connecticut, Idaho, +1 more states – Remote

🦌 Connecticut – Remote 🥔 Idaho – Remote 🤠 Texas – 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

• Subject Matter Expert (SME) with a background in Otolaryngology • Expands Aetna's medical management programs to address member needs across the continuum of care • Supports the Medical Management staff ensuring timely and consistent responses to members and providers • Leads all aspects of utilization review/quality assurance, directing case management • Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities • Acts 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 Otolaryngology, including post-graduate direct patient care experience specifically. • Previous UM experience with a Health Plan / Payor.

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families