CVS Health - Medical Director (National Accounts)
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Position Summary
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. In the Medical Director role, you will provide oversight for medical policy implementation, participate in the development and evaluation of clinical/medical programs, and expand Aetna's medical management programs to address member needs across the continuum of care.
Key Responsibilities:
- Support Medical Management staff ensuring timely responses to members and providers.
- Oversee utilization review/quality assurance and direct case management.
- Provide clinical expertise and business direction in support of medical management programs.
- Act as lead business and clinical liaison to network providers and facilities.
- Responsible for predetermination reviews and reviews of claim determinations.
Required Qualifications
- 2 or more years of experience in Health Care Delivery System (Clinical Practice and Health Care Industry).
- Active and current state medical license in NC without encumbrances.
- M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
Preferred Qualifications
- Electronic medical systems/record experience.
- Managed Care experience.
Pay Range
The typical pay range for this role is: $174,070.00 - $374,920.00. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits.
We anticipate the application window for this opening will close on: 10/31/2024.
We are an equal opportunity and affirmative action employer.
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