CVS Health Medical Director - SWAT Montpelier, Vermont
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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. 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. In addition, you will oversee utilization review/quality assurance, directing case management. In this role, you'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities and act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. You'll be responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
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. 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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