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.
Community Connect Lead - Grand Central/Cadence
The Medical University of South Carolina is an Equal Opportunity Employer. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. In addition to filling the role of a senior analyst within t...
Associate Medical Director - Concierge Care Management
Educates providers on issues concerning medical policies, utilization specifications, coding/medical necessity issues. Provides medical and administrative oversight of the health and disease management programs including budgeting, program strategic planning, and review of outgoing correspondence an...
UNIV - Director, Grants and Contract Accounting
The Medical University of South Carolina is an Equal Opportunity Employer. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. Direct grants and contracts experience in higher education a...
Market Director, Charleston, South Carolina
The Market Director’s core function is to drive new business and cultivate strategic partnerships. Concierge Auctions is the world's largest luxury real estate auction marketplace and has redefined how luxury properties are bought and sold through our exclusive auction platform. Since 2008, we've cl...
Administrative Director Pathology Practices
The Medical University of South Carolina is an Equal Opportunity Employer. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. Reporting to the System Administrative Officer and Chief of ...
Director Central Business Office
The Director of Central Business Office (D-CBO) directs all activities related to both hospital and physician patient accounting. The D-CBO is responsible for strategic development, compliant operations and operational deployment for all patient financial services activities performed in the Central...
UNIV - OPEN RANK - Chief of NCC Division & Director of NCC Unit - Department of Neurosurgery - NSICU
The Medical University of South Carolina is an Equal Opportunity Employer. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. ...
UNIV - SISU Administrative Director-Hollings Cancer Center
The SISU Administrative Director must demonstrate skills to effectively develop IIT study budgets and review and negotiate contract language (in collaboration with MUSC central contract office). The Medical University of South Carolina is an Equal Opportunity Employer. Medical University of South Ca...
Director, Medical Staff Services
Parter with the Director, Medical Staff Services for the Regional Health Network on the development and implementation of standardized processes and policies for credentialing, privileging, and additional Medical Staff functions. Cross Cover with the Director, Medical Staff Services for the Regional...
Cellular Therapy Clinical Director
The Medical University of South Carolina is an Equal Opportunity Employer. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. With support from the MUSC Office of Strategy and External A...