CVS Health
Medical Director Case Management
CVS Health, Annapolis, Maryland, United States, 21403
CVS Health - Medical Director Case Management - Annapolis, Maryland
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:Aetna is an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models in both our Dually Eligible Special Needs Plan (DSNP) and our Medicare-Medicaid Plan (MMP) programs. The Duals Care Management (CM) Medical Director will participate in designing, developing, and deploying our Models of Care across all markets.Primary Duties and Responsibilities:Provides clinical oversight of the Dual Eligible Special Needs Plan (DSNP) and Medicare-Medicaid Plan (MMP) care management teams.Partners closely with the Executive Director of Duals and other Duals Care Management leadership.Consults with plan medical staff regarding adverse determinations.Collaborates across the enterprise to ensure that the highest quality care is delivered to our members.Contributes to strategies for care management and community engagement.Assists in developing new health-related activities for dual members.Collaborates with the Learning and Performance Team to develop clinical training.Ensures timely execution of all deliverables in accordance with regulatory requirements.Collaborates with department leadership to interpret utilization data.Participate in UM activities as needed.Travel to Provider and Member Meetings as indicated.Required Qualifications:Active and current medical license (MD or DO) without encumbrances.Board Certification in Family Practice, Internal Medicine, or Geriatrics.3-5 years of Managed Care experience; Medicare and Medicaid including LTSS highly preferred.3-5 years of Care Management experience.Ability to work effectively in a highly matrixed organization.Ability to engage at all levels, including physicians, vendors, and community partners.Ability to work virtually with occasional travel (10%).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.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. The Company provides a fully-paid term life insurance plan to eligible employees and short-term and long-term disability benefits.We anticipate the application window for this opening will close on: 10/31/2024.Qualified 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.
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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.Position Summary:Aetna is an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models in both our Dually Eligible Special Needs Plan (DSNP) and our Medicare-Medicaid Plan (MMP) programs. The Duals Care Management (CM) Medical Director will participate in designing, developing, and deploying our Models of Care across all markets.Primary Duties and Responsibilities:Provides clinical oversight of the Dual Eligible Special Needs Plan (DSNP) and Medicare-Medicaid Plan (MMP) care management teams.Partners closely with the Executive Director of Duals and other Duals Care Management leadership.Consults with plan medical staff regarding adverse determinations.Collaborates across the enterprise to ensure that the highest quality care is delivered to our members.Contributes to strategies for care management and community engagement.Assists in developing new health-related activities for dual members.Collaborates with the Learning and Performance Team to develop clinical training.Ensures timely execution of all deliverables in accordance with regulatory requirements.Collaborates with department leadership to interpret utilization data.Participate in UM activities as needed.Travel to Provider and Member Meetings as indicated.Required Qualifications:Active and current medical license (MD or DO) without encumbrances.Board Certification in Family Practice, Internal Medicine, or Geriatrics.3-5 years of Managed Care experience; Medicare and Medicaid including LTSS highly preferred.3-5 years of Care Management experience.Ability to work effectively in a highly matrixed organization.Ability to engage at all levels, including physicians, vendors, and community partners.Ability to work virtually with occasional travel (10%).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.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. The Company provides a fully-paid term life insurance plan to eligible employees and short-term and long-term disability benefits.We anticipate the application window for this opening will close on: 10/31/2024.Qualified 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.
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