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.
Medical Director - Gulf South
A company is looking for a Medical Director - Gulf South to oversee health claims and make service authorization determinations. ...
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...
Medical Science Liaison, Immunology Central South
Territory; Central South- Houston. As a field-based medical expert, the MSL supports CSL Behring’s products and therapeutic areas by advancing scientific and collaborative relationships and acting as a conduit for timely knowledge exchange with key members of external healthcare communities and inte...
Medical Director Of Primary Care
The Medical Director's purview includes Old Town Clinic, as well as, Central City Concern's Hanson Clinic and Mobile Medical providers. The Site Medical Director of Primary Care - Old Town Clinic (OTC) collaborates with the Chief Medical Officer in all aspects of providing superior clinical care, es...
Site Medical Director
The Site Medical Director provides overall medical leadership surrounding all aspects of medical care and services for clients in residential treatment. The Site Medical Director will serve collaboratively with the Residential Operations Director to ensure excellent quality of care and safety. The S...
Lead Associate Ops, South Central OR Market, Medford, OR Area
We have an obsession for taking care of our customers and employees and making them feel welcomed and valued through building lasting relationships, doing the right thing, exceeding expectations, and having a strong commitment to diversity and inclusion.Using the latest banking solutions combined wi...
Medical Science Liaison, Immunology Central South
Territory; Central South- Houston. As a field-based medical expert, the MSL supports CSL Behring’s products and therapeutic areas by advancing scientific and collaborative relationships and acting as a conduit for timely knowledge exchange with key members of external healthcare communities and inte...
Medical Director - Primary Care (Old Town Clinic)
The Medical Director of Primary Care holds accountability in partnership with the Senior Director of Primary Care Operations and Clinics for the delivery of all primary care services provided at Central City Concern. In matters specifically related to medical and clinical supervision, the Senior Med...
Medical and Quality Director, General Pediatrics
Medical and Quality Director, General Pediatrics. The Department of Pediatrics at the Oregon Health and Science University (OHSU) seeks a General Pediatrics Medical and Quality Director to oversee an outpatient clinic's operations, an educational program, quality, and value-based performance metrics...
Medical Director Otolaryngology - Remote PST or MST
The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process ...