CVS Health
Medical Director Mid South
CVS Health, Raleigh, North Carolina, United States,
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary:Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.This is a remote based (work from home) position. The Medical Director will be part of the Mid South Region which includes North Carolina, South Carolina and Tennessee.The Medical Director must have a North Carolina State Medical License without encumbrances or the ability to obtain one within a reasonable period of time upon hire.Responsibilities:
Provide oversight for medical policy implementation.Participate in the development, implementation, and evaluation of clinical/medical programs.Support the Medical Management staff ensuring timely and consistent responses to members and providers.Oversee utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations.Conduct 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.Required Qualifications:Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.Active and current medical license without encumbrances.M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.Preferred Qualifications:Previous UM experience with a Health Plan / Payor.Previous UM experience as a Physician Advisor in a Health / Hospital system.Board Certification in Internal Medicine, Family Medicine, Emergency Medicine or Internal Medicine / Pediatrics preferred but will consider other specialties as well.Education:Medical Doctor or Doctor of Osteopathic MedicinePay 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit
jobs.CVSHealth.com/benefits .We anticipate the application window for this opening will close on: 03/31/2024.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.You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.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. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through
ColleagueRelations@CVSHealth.com . If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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Provide oversight for medical policy implementation.Participate in the development, implementation, and evaluation of clinical/medical programs.Support the Medical Management staff ensuring timely and consistent responses to members and providers.Oversee utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations.Conduct 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.Required Qualifications:Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.Active and current medical license without encumbrances.M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.Preferred Qualifications:Previous UM experience with a Health Plan / Payor.Previous UM experience as a Physician Advisor in a Health / Hospital system.Board Certification in Internal Medicine, Family Medicine, Emergency Medicine or Internal Medicine / Pediatrics preferred but will consider other specialties as well.Education:Medical Doctor or Doctor of Osteopathic MedicinePay 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit
jobs.CVSHealth.com/benefits .We anticipate the application window for this opening will close on: 03/31/2024.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.You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.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. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through
ColleagueRelations@CVSHealth.com . If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
#J-18808-Ljbffr