Medical Director - Radiation Oncology - MD or DO
About The Position
The Radiation Oncology Medical Director supports CVS Health’s Specialty oncology business by managing oncology-specific provider utilization, reviewing oncology-specific clinical data, and helping grow the oncology footprint. The role provides oversight and input for medical policy implementation and supports timely, consistent responses to members and providers. The Medical Director focuses on prior authorization and consultation cases and provides clinical, coding, and reimbursement expertise, directing case management when necessary. This is a remote, work-from-home position available to candidates living anywhere in the United States. It is full-time and exempt, with typical hours framed around 9:00 a.m. to 6:00 p.m. Eastern Time. Travel for team and client-facing meetings may occur one to two times per quarter. The role also participates in a weekend, holiday, and on-call rotation.
Requirements
- M.D. or D.O. with a current, active U.S. state medical license in good standing.
- Board certified in Radiation Oncology by a board recognized by the American Board of Medical Specialties or the American Osteopathic Association.
- Eligible to acquire additional state licensure as required.
- At least 3 years of relevant radiation oncology experience in patient care or managed care after residency.
- Ability to travel one to two times per quarter for team or client-facing meetings.
Nice To Haves
- Previous utilization management experience with a health plan or payor.
- Previous utilization management experience as a Physician Advisor in a health or hospital system.
Responsibilities
- Support oncology initiatives throughout the enterprise.
- Oversee utilization review and quality assurance.
- Conduct predetermination reviews and reviews of claim determinations.
- Provide input for medical policy implementation.
- Perform prior authorization, pre-certification, concurrent review, peer-to-peer calls, first-level appeals, special projects, and committee participation as needed.
- Provide clinical, coding, and reimbursement expertise and direct case management when necessary.
- Participate in the development, implementation, and evaluation of clinical and medical programs.
- Expand medical management programs to address member needs across the continuum of care.
- Support Medical Management staff in ensuring timely and consistent responses to members and providers.
- Provide clinical expertise and business direction for medical management programs through participation in clinical team activities.
- Act as a business and clinical liaison to network providers and facilities to support effective execution of medical services programs by clinical teams.
- Participate in a weekend, holiday, and on-call rotation.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- CVS Health bonus, commission, or short-term incentive program eligibility
- Company equity award program
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
