Medical Director – SWAT

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🔥 0 minutes 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

⚕️ 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 • Direct case management • Provide clinical expertise and business direction for medical management programs • Participate 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 • Conduct predetermination reviews and reviews of claim determinations • Provide clinical, coding, and reimbursement expertise

🎯 Requirements

• 2 or more years of experience in a health care delivery system, such as clinical practice, and the health care industry • Active and current state medical license without encumbrances • M.D. or D.O. • Board certification in a recognized specialty, including post-graduate direct patient care experience • Board certification in a recognized ABMS or AOA specialty, including post-graduate direct patient care experience • Health plan/payor experience preferred • Electronic medical systems/records experience preferred • Managed Care experience 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, based on eligibility