CVS Health Medical Director (West) Boise, Idaho Apply Now
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:
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. This is a remote-based (work from home) role preferably residing in Pacific NW/MTN states and requires an Oregon, Wyoming, or Nevada License (Washington, Utah, Idaho, Montana will also work) without encumbrances.
In the Medical Director role, you will provide oversight for medical policy implementation and participate in the development, implementation, and evaluation of clinical/medical programs to address member needs across the continuum of care.
Key Responsibilities:
- Oversee utilization review/quality assurance and be responsible for predetermination reviews.
- Conduct Prior Authorization/Pre Certification/Concurrent Reviews/Peer to Peer Calls/First Level Appeals/Special Projects and Committee participation when needed.
- Provide clinical expertise and direct case management when necessary.
- Act as lead business and clinical liaison to network providers and facilities to support the execution of medical services programs.
Required Qualifications:
- Active and current state medical license in either Oregon, Wyoming, or Nevada (Washington, Utah, Idaho, Montana will also work) without encumbrances.
- M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
Preferred Qualifications:
Previous UM experience with a Health Plan/Payor.
Education:
MD or DO
Pay Range:
The typical pay range for this role is: $174,070.00 - $374,920.00. 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 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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