CVS Health is seeking a remote Medical Director - North Central to provide clinical oversight and leadership for Aetna, a CVS Health company. You will be instrumental in implementing medical policy and developing clinical programs to improve member care across the continuum.
What You'll Do
- Provide oversight for medical policy implementation.
- Participate in the development, implementation, and evaluation of clinical and medical programs.
- Expand medical management programs to address member needs.
- Support Medical Management staff to ensure timely responses.
- Focus primarily on overseeing utilization review and quality assurance.
- Be responsible for predetermination reviews and review of claim determinations.
- Handle Prior Authorization, Pre Certification, Concurrent Reviews, Peer to Peer Calls, First Level Appeals, and Special Projects.
- Provide clinical, coding, and reimbursement expertise, and direct case management when necessary.
- Provide clinical expertise and business direction for medical management programs.
- Act as lead business and clinical liaison to network providers and facilities.
What We're Looking For
- Two (2) or more years of experience in a Health Care Delivery System (e.g., Clinical Practice and Health Care Industry).
- Active and current medical license without encumbrances.
- M.D. or D.O. with active and current Board Certification in an ABMS or AOA recognized specialty, including post-graduate direct patient care experience.
Nice to Have
- Five (5) or more years of clinical experience.
- Previous Utilization Management experience with a Health Plan, Payor, or as a Physician Advisor in a Healthcare system.
- Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Med/Peds.
Benefits & Compensation
- Compensation range: $174,070.00 - $374,920.00 plus an equity award target.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost programs including wellness screenings, tobacco cessation, weight management, counseling, and financial coaching.
- Paid time off, flexible work schedules, family leave, dependent care resources, tuition assistance, and more.
Work Mode
This is a fully remote position open to candidates based in Kentucky or Ohio.
CVS Health is committed to fostering a workplace where every colleague feels valued and that they belong. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.
