CVS Health Medical Director Midsouth Market Trenton, New Jersey Apply Now
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.
The following information aims to provide potential candidates with a better understanding of the requirements for this role.
Position Summary :
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. This is a remote based (work from home) role.
Candidates should reside in either FL or NC and need to have FL and / or NC license without encumbrances and willing to obtain the other.
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.
Responsibilities :
- Oversee utilization review / quality assurance and be responsible for predetermination reviews and reviews of claim determinations.
- Conduct Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects.
- Provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
- 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 Florida or North Carolina 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 / Peds Specialty Preferred.
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.
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.
We anticipate the application window for this opening will close on : 09 / 30 / 2024.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer.
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