Oncology Medical Director

CVS Health•Work At Home-Connecticut, CT

7d•$174,070 - $374,920•Remote

About The Position

Aetna is launching an Oncology Care Model that provides specialized care pathways to members throughout their oncology treatment. The Oncology Medical Director is a board-certified oncologist who leads the new team and oversees clinical governance, adverse determinations, physician-to-physician reviews, and consultation on complex medical-necessity decisions. The role supports an interdisciplinary team that includes a Nurse Practitioner, Nurse, Pharmacist, Behavioral Health Specialist, and Oncology Companion. This fully remote position may be performed from anywhere in the contiguous United States. Travel for team and client-facing meetings may occur one to two times per quarter; overnight travel may be required up to 20%. The director develops the strategy and vision for oncology programs, provides clinical oversight, evaluates treatment plans and outcomes, develops policies and procedures, and promotes compliance with industry standards and regulatory requirements. The role also collaborates with executives and interdisciplinary leaders, coordinates services across oncology and other healthcare areas, builds relationships with healthcare organizations and stakeholders, administers medical policy, and oversees medical management programs, quality assurance, provider relationships, determination reviews, and clinical, coding, and reimbursement policies. The position manages team performance through regular feedback and formal performance reviews. The role requires an unrestricted medical license in the state where the candidate is located, current continuing medical education compliance, and board certification in Medical Oncology. A minimum of five years of post-fellowship oncology experience is required. The position is full-time and eligible for a base salary range of $174,070 to $374,920, as well as a CVS Health bonus, commission or short-term incentive program and an equity award target. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

Medical Doctor in good standing, with no restrictions.
Unrestricted license to practice medicine in the state where the candidate is located.
Must remain current with continuing medical education requirements for board certification(s) and licensure, and maintain skills in medical and management areas during employment.
ABIM Certification in Medical Oncology or AOBIM Oncology Subspecialty Certification.
At least five years of post-fellowship oncology experience.
Overnight travel up to 20%.
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).

Nice To Haves

More than 10 years of post-fellowship oncology experience.
Prior utilization management experience.
Problem-solving and decision-making skills.
Ability to multitask and handle competing deadlines; flexibility and adaptability.
Ability to deal tactfully with customers and the community.
Strong communication skills for leading a team.
Strong execution and delivery skills, including planning, delivering, and supporting.
Ability to weigh the relative costs and benefits of potential actions to choose an appropriate course.
Ability to function in clinical settings with diverse cultural dynamics among clinical staff and patients.
Knowledge of phases of care transitions and resources available for patients.
Digital literacy skills.
Ability to handle sensitive information ethically and responsibly.

Responsibilities

Develop the strategy and vision of oncology programs to support consistent delivery of high-quality care.
Provide clinical oversight and guidance throughout the planning, coordination, and provision of oncology services.
Review and approve treatment plans, evaluate clinical outcomes, and monitor oncology provider performance.
Develop and implement policies and procedures aligned with organizational objectives and focused on improving oncology services.
Keep current with industry standards, regulatory requirements, and best practices to support clinical compliance and patient-centered care.
Collaborate with executives and interdisciplinary leaders to design and implement approaches that address the needs of patients with oncology conditions.
Lead cross-functional meetings, committees, and initiatives to coordinate care and integrate oncology with other healthcare services.
Develop relationships with healthcare organizations, community agencies, and stakeholders to improve care coordination for people with oncology needs.
Administer medical policy and oversee systems for developing, implementing, and evaluating clinical and medical programs.
Develop strategies to expand medical management programs across the continuum of care.
Implement quality assurance goals and objectives and advise on organizational standards for medical management programs.
Build relationships with network provider and facility leaders to support medical services programs.
Direct processes for predetermination reviews and reviews of claim determinations.
Formulate clinical, coding, and reimbursement policies.
Ensure timely and consistent responses to members and providers.
Manage team performance through regular feedback and formal performance reviews, supporting service quality, engagement, motivation, and team development.
Provide clinical governance, review adverse determinations, conduct physician-to-physician reviews, and consult on complex medical-necessity decisions.
Support the Oncology Care Model's Nurse Practitioner, Nurse, Pharmacist, Behavioral Health Specialist, and Oncology Companion.