CVS Health Medical Director - Medical Affairs (Oncology) Concord, New Hampshire
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.
Position Summary
CVS Health, a Fortune 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Board Certified Oncologist for this opportunity.
The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services and pipeline activities.
The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role, you may provide consultative clinical support to Account Management in support of Key Clients as assigned.
The Medical Director transacts Utilization Management (UM) activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and CVS Health coverage policies.
Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge, and cross-functional thinking and decision-making. Medical Directors represent the clinical decision-making and professional thought process of the prescriber as a partner across the enterprise’s decisions and planning.
Responsibilities include:
- Providing oversight of a portion of CVS Health's clinical programs and commercial client program support.
- Completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs, and individual client requested coverage determinations or appeals.
- Participating in inter-rater review activities and other quality oversight processes for internal Director UM decisions.
- Performing special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs.
Required Qualifications
- Minimum of 5 years clinical experience in direct patient care.
- 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs.
- Unrestricted license to practice medicine in the state in which the candidate is located.
Preferred Qualifications
- Combination of five years of management and/or clinical experience in a managed care environment and health administration.
- Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired.
- Internal Medicine or Family Medicine Board Certification highly desired.
- Proficiency in MS Office Suite.
Education
- Must be a graduate of an accredited Medical School and Residency Program.
- ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine).
- Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employment.
Pay Range
The typical pay range for this role is: $174,070.00 - $374,900.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits.
We anticipate the application window for this opening will close on: 10/31/2024.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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