Medical Director

Job not on LinkedIn

🔥 0 minutes ago

🔔 Pennsylvania, Virginia, +1 more states – Remote

🔔 Pennsylvania – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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, including prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, and first-level appeals • Participate in special projects and committees as needed • Provide clinical expertise and direct case management when necessary • Support medical management programs through clinical team activities • Serve as lead business and clinical liaison to network providers and facilities • Support effective execution of medical services programs by clinical teams

🎯 Requirements

• M.D. or D.O. • Board Certification in an ABMS or AOA recognized specialty • Post-graduate direct patient care experience • Active and current state medical license • Active and current state medical license in either PA, WV, or DE without encumbrances preferred • 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