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 :
The Aetna Duals Center of Excellence (COE) operates Duals Integrated Plans : Ohio, Illinois, Michigan, Virginia, Pennsylvania, and New Jersey offering a variety of physical and behavioral health programs and services to its membership.
Aetna is looking for a Medical Director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.
The Medical Director is a work-at-home position located anywhere in the US.
The Medical Director can work from any state but preferred work schedule will be Central Standard time 8 : 00 AM - 5 : 00 PM.
Weekend / Holiday call is scheduled for approximately 2 to 4 times per year to cover urgent cases; and can be done from your laptop.
Fundamental Components :
- Utilization management The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials.
- Appeals The medical director will perform appeals in their base plan and in the round robin based on same or similar specialty needs.
- Pharmacy coverage The medical director will perform pharmacy reviews.
- The medical director will participate in and be able to lead daily rounds.
Required Qualifications :
Minimum 3-5 years of clinical practice experience.
Two (2) + years of experience in managed care (Medicare and / or Medicaid)
Experience with managed care (Medicare and Medicaid) utilization review preferred
MD or DO; Board certification in an ABMS or AOA recognized specialty is required.
Active and current state medical license without encumbrances is required. Multiple state licensure a plus.
Preferred Qualifications :
Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System.
Licensed in or willing to obtain license in at least one state where we have an Integrated plan.
Education
MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)
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.
Sr. Finance Analyst - Resource Center of Excellence (COE)
The Product and Technology (P&T) Finance team is seeking a self-driven, analytical problem-solver, and process-oriented Senior Finance Analyst to join the P&T Central Financial Planning & Analysis (FP&A) team and be part of the Resource Center of Excellence (COE) organization. Finance Analyst - Reso...
Assistant Director Of Nursing (must Be Rn)
We are committed to providing an environment where your leadership skills can shine without the overwhelming responsibilities of a Director of Nursing. Unlock Your Leadership Potential: Join Us as an Assistant Director of Nursing!. Ready to make a real impact? Are you an experienced Registered Nurse...
Clinical Research Nurse Coordinator - Cancer Center
At the University of Kansas Medical Center, a reasonable estimate for the starting pay range will be the minimum to midpoint of the posted range, taking into account the combination of factors listed above. One paid discretionary day is available after six months of employment, and paid time off for...
Relief Veterinarian
Looking for a part-time or relief veterinarian opportunity? At the Animal Medical Center of Mid-America (AMCMA), we understand your need to remain independent, flexible and have better work/life balance, while having interesting and varied assignments. We are part of the Humane Society of Missouri (...
Director of Cancer Center
Ability to present ideas and information to various levels of management and boards • Strategic Vision – Participates in guiding physicians and key members of the team to pursue innovative opportunities to develop and expand SoutheastHEALTH Cancer Center's business enterprises • Ability to dev...
Assistant Professor- Non-Invasive Cardiologist
If selected as a final candidate for this position, you may be required to complete the Association of American of Universities Representations and Warranties document and sign a release of records that will allow the University of Kansas Medical Center to conduct a further background check with for...
Radiologic Technologist: Capital Region Medical Center
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. RADIOLOGIC TECHNOLOGIST: CAPITAL REGION MEDICAL CENTE...
Certified Asbestos Worker - Facilities
At the University of Kansas Medical Center, a reasonable estimate for the starting pay range will be the minimum to midpoint of the posted range, taking into account the combination of factors listed above. It is only a summary of the typical functions of the job, not an exhaustive list of all possi...
Assistant Professor - Population Health
If selected as a final candidate for this position, you may be required to complete the Association of American of Universities Representations and Warranties document and sign a release of records that will allow the University of Kansas Medical Center to conduct a further background check with for...
Early Head Start/Head Start Limited Term Teacher Aide
At the University of Kansas Medical Center, a reasonable estimate for the starting pay range will be the minimum to midpoint of the posted range, taking into account the combination of factors listed above. One paid discretionary day is available after six months of employment, and paid time off for...