Medical Director

Job not on LinkedIn

🔥 13 hours ago

🏈 Alabama, Louisiana, +2 more states – Remote

🏈 Alabama – Remote ⚜️ Louisiana – Remote 🎸 Mississippi – Remote 🍑 Georgia – 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

• Oversee utilization review for health systems in the Georgia and Gulf States region • Oversee utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals • 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 with timely and consistent responses to members and providers • Conduct or oversee prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, first-level appeals, and special projects • Participate in committees as needed • Collaborate and work as part of the Medical Director team

🎯 Requirements

• Two (2) 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 • 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 Microsoft Outlook and Teams • Preferred: residence in Louisiana, Mississippi, Alabama, or Arkansas • Preferred: previous utilization management experience with a health plan/payor • Preferred: previous utilization management experience as a Physician Advisor in a health/hospital system • Preferred: board certification in Internal Medicine, Family Medicine, or Emergency Medicine

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • 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

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