CVS Health
Medical Director Aetna Duals Center of Excellence
CVS Health, Des Moines, Iowa, United States, 50319
CVS Health - Medical Director Aetna Duals Center of Excellence - Des Moines, Iowa
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.Position Summary:The Aetna Duals Center of Excellence (COE) operates Duals Integrated Plans: Ohio, Illinois, Michigan, Virginia, Pennsylvania, and New Jersey offering a variety of physical and behavioral health programs and services to its membership.Aetna is looking for a medical director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. The medical director is a work-at-home position located anywhere in the US.Responsibilities:Utilization management – Perform concurrent and prior authorization reviews with peer to peer coverage of denials.Appeals – Perform appeals in their “base plan” and in the round robin based on “same or similar specialty” needs.Pharmacy coverage – Perform pharmacy reviews.Participate in and be able to lead daily rounds.Required Qualifications:Minimum 3-5 years of clinical practice experience.Two (2) + years of experience in managed care (Medicare and/or Medicaid).Experience with managed care (Medicare and Medicaid) utilization review preferred.MD or DO; Board certification in an ABMS or AOA recognized specialty is required.Active and current state medical license without encumbrances is required. Multiple state licensure a plus.Preferred Qualifications:Previous experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System.Licensed in or willing to obtain a license in at least one state where we have an Integrated plan.Education:MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)Pay Range:The typical pay range for this role is: $174,070.00 - $374,920.00.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.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.We anticipate the application window for this opening will close on: 10/01/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.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.
#J-18808-Ljbffr
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.Position Summary:The Aetna Duals Center of Excellence (COE) operates Duals Integrated Plans: Ohio, Illinois, Michigan, Virginia, Pennsylvania, and New Jersey offering a variety of physical and behavioral health programs and services to its membership.Aetna is looking for a medical director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. The medical director is a work-at-home position located anywhere in the US.Responsibilities:Utilization management – Perform concurrent and prior authorization reviews with peer to peer coverage of denials.Appeals – Perform appeals in their “base plan” and in the round robin based on “same or similar specialty” needs.Pharmacy coverage – Perform pharmacy reviews.Participate in and be able to lead daily rounds.Required Qualifications:Minimum 3-5 years of clinical practice experience.Two (2) + years of experience in managed care (Medicare and/or Medicaid).Experience with managed care (Medicare and Medicaid) utilization review preferred.MD or DO; Board certification in an ABMS or AOA recognized specialty is required.Active and current state medical license without encumbrances is required. Multiple state licensure a plus.Preferred Qualifications:Previous experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System.Licensed in or willing to obtain a license in at least one state where we have an Integrated plan.Education:MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)Pay Range:The typical pay range for this role is: $174,070.00 - $374,920.00.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.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.We anticipate the application window for this opening will close on: 10/01/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.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.
#J-18808-Ljbffr