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Position Summary:
Position Purpose: Assist the Chief Medical Officer (CMO) directing and coordinating the medical management, quality improvement and credentialing functions for the business unit.
Resident of Oklahoma is required for this position. There will be expected travel of 10 - 20% throughout the state on an as-needed basis for meetings with key stakeholders (both internal & external).
Remote Work from Home position as long as the Behavioral Health Medical Director resides in the state of Oklahoma.
Responsibilities:
- Provides medical leadership for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
- Assists the CMO in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Assists the CMO in the functioning of the physician committees including committee structure, processes, and membership. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
- Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
- Develops alliances with the provider community and may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
Required Qualifications:
- Five (5) + years of clinical experience post-residency.
- Board Certified by the American Board of Psychiatry & Neurology.
- Active medical license in the state of Oklahoma without encumbrances.
- MD or DO.
Preferred Qualifications:
- Prior UM Experience with a Health Plan or Review Organization.
- Prior Managed Care Experience.
- Prior Medicaid Experience.
Education:
MD (Medical Doctor) or DO (Doctor of Osteopathy).
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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions.
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