Medical Director

Job not on LinkedIn

🔥 13 hours ago

🌽 Illinois, Minnesota, +2 more states – Remote

🌽 Illinois – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🧀 Wisconsin – 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 and 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, and first-level appeals • Participate in special projects and committees as needed • Provide clinical, coding, and reimbursement expertise • Direct case management when necessary • 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

• Five (5) or more years of experience in a health care delivery system, such as clinical practice and the health care industry • Active and current medical license without encumbrances in one of the Midland States (IL, MO, MN, WI) • M.D. or D.O. • Active and current board certification in an ABMS- or AOA-recognized specialty • Post-graduate direct patient care experience • Previous utilization management experience with a health plan, payor, or physician advisor in a healthcare system preferred • Board certification in Internal Medicine, Family Medicine, Emergency Medicine, Med/Peds, or General Surgery preferred

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program • Equity award program