About The Position
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary This Executive Medical Director - Medical Policy & Operations leads a team responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This leader collaborates in the development and execution of clinical and payment policies to ensure the accurate administration of plan benefits for medically appropriate services. This Executive Director works across Aetna in a highly collaborative partnership with multiple business units to drive better clinical and business outcome.
Requirements
- Five (5) years or more of experience in clinical practice.
- Three (3) years or more of health plan/payor experience.
- Medical Director Board Certification is required
- Active and current state medical license without encumbrances
- MD or DO
Nice To Haves
- Deep knowledge of Aetna Clinical and Payment Policy
- Deep experience with Aetna transactional tools including MedCompass, MedHok, CATS, ATV, TPS.
- Expertise in digital tools like FastKeys.
- Demonstrated ability to recruit, train, and retain Medical Directors
- Deep knowledge of Clinical Claim Review policy, procedure, and workflows.
Benefits
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
Education Level
Ph.D. or professional degree
Number of Employees
5,001-10,000 employees
