Medical Director

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About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Thank you for your interest in furthering your career with CVS Health. This site is dedicated to hosting all CVS Health openings across the enterprise, and is only available to our internal colleagues. Here you can search openings, maintain your internal candidate profile, upload resumes, and set up a search agent for newly posted jobs that match your search criteria. We encourage you to discuss your career goals and interest in a new role with your leader.  Should you be considered for a new role, a notification will be sent to your current leader during the selection process. Note: If you are a contractor or external consultant and have reached this page, please logout of this internal employee Career Site and apply via the CVS Careers Page. 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. Preferred candidates will work Eastern or Central Time hours and reside in the Great Lakes region (IL, IN, MI) . • 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 and quality assurance while being responsible for predetermination reviews and review 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: • Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. • Active and current medical license without encumbrances • M.D. or D.O., Active and Current 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/ Physician Advisor in a Healthcare system.  • Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Gynecology Preferred. Education: • Medical Doctor or Doctor of Osteopathic Medicine Pay Range The typical pay range for this role is: $174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual f

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