CVS Health
Medical Director (Medical Affairs)
CVS Health, Springfield, Illinois, us, 62777
CVS Health Medical Director (Medical Affairs) Springfield, Illinois Apply Now
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.Position SummaryCVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs). The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services and pipeline activities, and provision of clinical leadership to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients.The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management (UM) activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies.Key ResponsibilitiesModel the highest levels of clinical integrity, knowledge, and cross-functional thinking and decision-making.Provide oversight of a portion of CVS Health's clinical programs and commercial client program support.Complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs, and individual client requested coverage determinations or appeals when appropriate.Participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions.Perform special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs.Required QualificationsMinimum of 5 years clinical experience in direct patient care.2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs.Unrestricted license to practice medicine in the state in which the candidate is located.Preferred QualificationsCombination of five years of management and/or clinical experience in a managed care environment and health administration.Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired.Internal Medicine or Family Medicine Board Certification highly desired.Proficiency in MS Office Suite.EducationGraduate of an accredited Medical School and Residency Program.ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine).Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia.Required annual Continuing Medical Education (CME) up to date.Pay RangeThe 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. 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.We anticipate the application window for this opening will close on: 09/30/2024.We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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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.Position SummaryCVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs). The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services and pipeline activities, and provision of clinical leadership to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients.The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management (UM) activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies.Key ResponsibilitiesModel the highest levels of clinical integrity, knowledge, and cross-functional thinking and decision-making.Provide oversight of a portion of CVS Health's clinical programs and commercial client program support.Complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs, and individual client requested coverage determinations or appeals when appropriate.Participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions.Perform special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs.Required QualificationsMinimum of 5 years clinical experience in direct patient care.2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs.Unrestricted license to practice medicine in the state in which the candidate is located.Preferred QualificationsCombination of five years of management and/or clinical experience in a managed care environment and health administration.Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired.Internal Medicine or Family Medicine Board Certification highly desired.Proficiency in MS Office Suite.EducationGraduate of an accredited Medical School and Residency Program.ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine).Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia.Required annual Continuing Medical Education (CME) up to date.Pay RangeThe 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. 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.We anticipate the application window for this opening will close on: 09/30/2024.We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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