CVS Health Medical Director - SWAT
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. In the Medical Director role, you will provide oversight for medical policy implementation. You'll participate in the development, implementation, and evaluation of clinical/medical programs and expand Aetna's medical management programs to address member needs across the continuum of care. You will support the Medical Management staff ensuring timely and consistent responses to members and providers.
Responsibilities
- Oversee utilization review/quality assurance, directing 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 e.g., Clinical Practice and Health Care Industry.
- Active and current state medical license 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. 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, 401(k), Employee Stock Purchase Plan, and numerous well-being programs.
For more detailed information on available benefits, please visit Benefits | CVS Health.
We anticipate the application window for this opening will close on: 12/31/2024.
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.
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