Medical Director

We're building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience. At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, and prioritise safety and quality.

As a Medical Director at Aetna, a CVS Health Company, you will provide oversight for medical policy implementation, develop and implement clinical programs, and expand medical management programs to address member needs. You will support Medical Management staff, oversee utilisation review and quality assurance, and be responsible for predetermination reviews, prior authorisation, pre-certification, concurrent reviews, peer-to-peer calls, and first-level appeals.

Responsibilities:

• Provide clinical expertise and business direction in support of medical management programs
• Participate in clinical team activities and act as a lead business and clinical liaison to network providers and facilities
• Oversee utilisation review and quality assurance
• Conduct predetermination reviews, prior authorisation, pre-certification, concurrent reviews, peer-to-peer calls, and first-level appeals
• Provide clinical expertise and direct case management when necessary

Requirements:

• M.D. or D.O., Board Certification in an ABMS or AOA recognised specialty
• Active and current US medical license without encumbrances

Preferred Qualifications:

• Active and current state medical license in PA, WV, or DE without encumbrances
• Previous utilisation management experience with a health plan or payor

Pay Range: $174,070.00 - $374,920.00

Benefits:

• Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources