Radiation Oncology 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 prioritize safety and quality in everything they do.

The Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology-specific utilization of providers, clinical reviews of oncology-specific data, and assists with growing the oncology footprint. As a Medical Director, you will provide oversight for medical policy implementation, ensure timely and consistent responses to members and providers, and focus on prior authorization cases and consultation cases.

In this role, you will:

• Support Oncology initiatives throughout the enterprise
• Oversee utilization review and quality assurance, focusing on predetermination reviews and review of claim determinations
• Provide input for medical policy implementation
• Participate in prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, first-level appeals, and special projects
• Provide clinical, coding, and reimbursement expertise, as well as direct case management when necessary
• Participate in developing, implementing, and evaluating clinical and medical programs
• Support Medical Management staff in ensuring timely and consistent responses to members and providers
• Act as a business and clinical liaison to network providers and facilities
• Participate in weekend, holiday, and on-call rotations

Requirements:

• M.D. or D.O. with a current, active U.S. state medical license in good standing
• Board certified in Radiation Oncology, recognized by the American Board of Medical Specialties or American Osteopathic Association
• Eligible to acquire additional state licensure as required
• 3+ years of relevant radiation oncology experience in a patient care or managed care setting post-residency
• Ability to travel 1-2 times/quarter for team or client-facing meetings

Preferred Qualifications:

• Previous UM experience with a Health Plan/Payor
• Previous UM experience as a Physician Advisor in a Health/Hospital system

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

This position is eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.