Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.
CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs).
Job Overview This is a full-time, remote-based, work-from-home opportunity.
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 clinical leadership to various internal departments and clients.
Responsibilities Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge, and cross-functional thinking, and decision-making. Medical Directors represent the clinical decision-making and professional thought process of the prescriber as a partner across the enterprise's decisions and planning.
Medical Directors are responsible for:
- Reviewing a broad range of clinical cases and coverage requests, including specialty medications, oncology therapies, biologics, and newly marketed drugs
- Providing consultative clinical support to Account Management in support of Key Clients as assigned
- Completing assigned medication utilization reviews and/or medical necessity appeals for commercial clients, governmental programs, and individual client-requested coverage determinations or appeals when appropriate
- Participating in inter-rater review activities and other quality oversight processes for internal Director UM decisions
- Providing oversight of a portion of CVS Health's clinical programs and commercial client program support
- Sharing in reviews of utilization management criteria and clinical policy revisions/reviews
- Performing special clinical investigations and research as requested by the Senior Medical Director
Requirements
- ABMS or AOA Board Certified in Internal Medicine or Family Medicine. CURRENT FAMILY MEDICINE OR INTERNAL MEDICINE BOARD CERTIFICATION IS REQUIRED.
- Additional subspecialty board certification is strongly preferred.
- Minimum of 5 years of clinical experience in direct patient care.
- 2 or more years of 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 Qualifications
- Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as teammates.
- Master's Degree in Public Health Administration or MBA preferred, UM/QA certification desired.
- Proficiency in MS Office Suite.
Education
- Must be a graduate of an accredited Medical School and Residency Program.
- 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 and must remain current in medical and management areas during employment.
Pay Range The typical pay range for this role is: $174,070.00 - $374,920.00
Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.