✨ About The Role
- The Medical Director will provide clinical support and consultative activities across the Pharmacy Benefit Management (PBM) sector.
- Responsibilities include transacting Utilization Management activities such as prior authorization and appeals.
- The role involves responding to prescriber inquiries related to Utilization Management transactions and CVS Health coverage policies.
- Medical Directors will oversee a portion of CVS Health's clinical programs and commercial client program support.
- Participation in inter-rater review activities and quality oversight processes for internal decisions is expected.
âš¡ Requirements
- The ideal candidate will have a board certification in Family Medicine or Internal Medicine.
- A minimum of 5 years of clinical experience in direct patient care is essential for this role.
- Candidates should possess at least 2 years of proven experience in clinical outcomes, with a solid understanding of medical statistics and regulatory agencies.
- An unrestricted license to practice medicine in the state of residence is required.
- Experience in a managed care environment and health administration is preferred, along with strong teamwork skills.