Medical Director

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – 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

• Provide oversight for medical policy implementation • 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 in providing timely and consistent responses to members and providers • Oversee utilization review and quality assurance • Conduct predetermination reviews and reviews of claim determinations • Perform prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, first-level appeals, special projects, and committee participation • Provide clinical, coding, and reimbursement expertise • Direct case management when necessary • Provide clinical expertise and business direction for medical management programs • Act as lead business and clinical liaison to network providers and facilities

🎯 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 (FL preferred) • M.D. or D.O. • Board Certification in an ABMS or AOA recognized specialty • Post-graduate direct patient care experience • Previous UM experience with a Health Plan / Payor preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being