Medical Director

4 weeks ago


Trenton, New Jersey, United States CVS Health Full time

At CVS Health, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. As a Medical Director, you'll play a critical role in shaping our medical management programs to address member needs across the continuum of care.

Key Responsibilities:

  • Provide oversight for medical policy implementation and development, implementation, and evaluation of clinical/medical programs.
  • Support the Medical Management staff in ensuring timely and consistent responses to members and providers.
  • Oversee utilization review/quality assurance, predetermination reviews, and reviews of claim determinations, including Prior Authorization/Pre Certification/Concurrent Reviews/Peer to Peer Calls/First Level Appeals/Special Projects and Committee participation when needed.
  • Provide clinical, coding, and reimbursement expertise, as well as directing case management when necessary.
  • 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.

Requirements:

  • Two (2) or more years of experience in Healthcare Delivery System, e.g., Clinical Practice and Healthcare Industry.
  • Active and current state medical license without encumbrances.
  • M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.

What We Offer:

  • A competitive pay range of $174,920.00.
  • A comprehensive benefits package, including medical, dental, and vision benefits.
  • A 401(k) retirement savings plan and an Employee Stock Purchase Plan.
  • A fully-paid term life insurance plan and short-term and long-term disability benefits.
  • Well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

CVS Health is an Equal Opportunity Employer.



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