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Medical Director - New York Region - Remote Eligible

Oversee the implementation of innovative medical management programs to enhance patient care.
RemoteNew York
Senior
$174,070 - 374,920 USD / year
2 weeks ago
CVS Health

CVS Health

CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.

✨ About The Role

- The Medical Director will oversee medical policy implementation and participate in the development and evaluation of clinical programs. - This role involves expanding Aetna's medical management programs to address member needs across the continuum of care. - The Medical Director will focus on utilization review and quality assurance, including predetermination reviews and claims determinations. - Responsibilities include conducting prior authorization, pre-certification, concurrent reviews, and first-level appeals. - The Medical Director will act as a liaison to network providers and facilities to support effective execution of medical services programs.

âš¡ Requirements

- The ideal candidate will have at least two years of experience in the healthcare delivery system, including clinical practice and the healthcare industry. - A current and active state medical license without encumbrances is required for this position. - Candidates should possess an M.D. or D.O. degree and board certification in an ABMS or AOA recognized specialty. - Previous experience in utilization management with a health plan or payor is preferred. - The successful candidate will have strong clinical, coding, and reimbursement expertise.
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Medical Director - New York Region - Remote Eligible
RemoteNew York
$174,070 - 374,920 USD / year
Healthcare Administration
About CVS Health
CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.