Medical Director - Radiation Oncology - MD or DO
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. The Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. This is a remote based (work from home) position One may live anywhere in the United States This is a full-time/exempt-level position, and the hours will typically be around the framework of 9:00-6:00 Eastern Time Travel for team meetings and client-facing meetings could happen 1-2 times/quarter
Requirements
- M.D. or D.O. with a current, active, U.S. state medical license that is in good standing
- Board certified in Radiation Oncology, recognized by the American Board of Medical Specialties, or American Osteopathic Association
- Eligible to acquire additional state licensure as required
- 3+ years of relevant radiation oncology experience in a patient care, or managed care setting post residency
- Ability to travel 1-2 times/quarter for team, or client-facing meetings
Nice To Haves
- Previous UM experience with a Health Plan / Payor.
- Previous UM experience as a Physician Advisor in a Health / Hospital system.
Responsibilities
- Support Oncology initiatives throughout the enterprise
- Oversee utilization review and quality assurance
- Responsible for predetermination reviews and review of claim determinations
- Provide input for medical policy implementation
- Handle Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation
- Provide clinical, coding, and reimbursement expertise
- Direct case management when necessary
- Participate in the development, implementation, and evaluation of clinical / medical programs
- Expand 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
- Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities
- Act as a business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams
- Participate in a weekend, holiday and on-call rotation
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
