Medical Director - Commercial

CVS Health•Work At Home-Texas, VT

5d•$174,070 - $374,920•Remote

About The Position

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. 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 and can be based anywhere in the US.

Requirements

2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Active and current state medical license without encumbrances
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.

Nice To Haves

Five or more years of direct patient care experience
Previous UM experience with a Health plan/payor experience.
Electronic medical systems/record experience
Managed Care experience
Board certification in Internal Medicine, Family Medicine, Emergency Medicine, OB/GYN or Med/PM&R

Responsibilities

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.
Support the Medical Management staff ensuring timely and consistent responses to members and providers. This includes Prior Authorization/Pre-Certification/Concurrent Reviews/Peer to Peer calls/First Level Appeals/Special Projects and Committee participation when needed.
Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
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.