Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.
This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary :
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care.
We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
This is a remote based (work from home) role. Candidates must have a TX License without encumbrances. PM&R Specialty desired.
In the Medical Director role you will provide oversight for medical policy implementation.
You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
You will support the Medical Management staff ensuring timely and consistent responses to members and providers.
As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews and reviews of claim determinations.
This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
The Medical Director will act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Required Qualifications :
- Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and current Texas state medical license without encumbrances
- M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
Preferred Qualifications :
Previous UM experience with a Health Plan / Payor.
Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, OB / GYN or Med / PM&R
Education : MD or DO
MD or DO
Pay Range
The typical pay range for this role is :
$174,070.00 - $374,900.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.
The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
This position also includes an award target in the company’s equity award program.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.
The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.
The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.
CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.
Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
Primary Care Regional Clinical Program Medical Director for the Monroe, WI market
SSM Health Monroe Clinic is searching for a talented and experienced Primary Care physician leader to join our organization as Primary Care Clinical Program Medical Director. Medical Directors partner with Operation Leaders to monitor, manage, and improve the delivery of primary care services. As th...
Medical Director (South Central Market)
In the Medical Director role you will provide oversight for medical policy implementation. The Medical Director will act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. You will participa...
Staff - Director Registered Nurse (RN) - NICU - Neonatal Intensive Care - $100K-150K per year
Core Medical-Perm is seeking a Registered Nurse (RN) NICU - Neonatal Intensive Care Director for a nursing job in Marquette, Michigan. Sign on Bonus and Relocation assistance offered CoreMedical Group is a nationally recognized leader in the medical recruitment and employment industry. OB or NICU ma...
Physician - Medical Director - Anesthesiology/Critical Care
The Medical Director partners with faculty from Cardiac Surgery, Vascular Surgery, and Intensivists (Anesthesiology/SICU) as well as the Clinical Nursing Director and Service Line partners to provide leadership for the clinical operations of Cardiovascular Patients, creating a culture that engenders...
Hospice – Medical Director Opportunity
Trinity Health Grand Haven, on behalf of Hospice of North Ottawa Community, is seeking a full-time physician to serve as Medical Director for the Hospice program located in Grand Haven, Michigan. The Hospice Medical Director will:. Will work with the Executive Director, Director of Clinical Services...
Medical Director of Physical Health
The Medical Director of Physical Health to provide clinical oversight Medical Respite and the Behavioral Health Home Programs. Position Title:Medical Director of Physical Health. The Medical Director will ensure quality care delivery, regulatory compliance, and clinical best practices for the progra...
Medical Director
Physician must be able to utilize electronic/online medical tools such as EHR systems and state/county medical systems utilized for Death Certificates and administrative functions. Leading the charge in healthcare innovation, Theoria Medical offers a unique blend of medical excellence and technologi...
Medical Director of Adult Critical Care
Physician to serve as the Medical Director of Adult Critical Care. Sparrow delivers exceptional quality care in a diverse and family-friendly community and is committed to improving access to medical care across the Mid-Michigan region. Excellent compensation and benefits including medical, dental a...
Executive Director, Medical Sub-Specialty Society
Minimum of 3 years of experience in senior level medical non-profit association management. The founders’ vision for Veritas was to build a solid management team dedicated to the medical sub-specialty market that is % customer service focused, with specific attention to implementing creative, innova...
I/P Medical Director: NEW facility in Byron Center, MI!
Medical Education Loan repayment assistance, if needed. Full benefits plan including: Medical/Dental/Vision insurance plans, PTO, Matching 401k plan, and much more!. ...