Medical Director

Job not on LinkedIn

🔥 13 hours ago

🦌 Connecticut, Maine, +5 more states – Remote

🦌 Connecticut – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🗽 New York – Remote 🍂 Massachusetts – Remote ⚓ Rhode Island – Remote 🍁 Vermont – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 1 day.
• Jobs at this company usually fill in 21 days.

Apply Now

Find Similar Remote Jobs

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

• Oversee utilization review for health systems in the New England Region • Perform and oversee utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals • 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 • Handle Prior Authorization, Pre Certification, Concurrent Reviews, Peer to Peer Calls, First Level Appeals, Special Projects, and Committee participation when needed • Learn about the New England market, including hospitals, outpatient networks, and value-based care relationships

🎯 Requirements

• Two (2) or more years of experience in Health Care Delivery System, e.g., Clinical Practice and Health Care Industry • Active and current medical license without encumbrances • M.D. or D.O. • Active and Current Board Certification in an ABMS or AOA recognized specialty • Post-graduate direct patient care experience • Experience with technology such as Microsoft Outlook and Teams • Ability to obtain a New England state medical license within a reasonable timeframe, if not already licensed • Previous UM experience with a Health Plan / Payor preferred • Previous UM experience as a Physician Advisor in a Health / Hospital system preferred • Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine 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

📊 Check your resume score for this job

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

Upload Resume