Medical Director – Molecular Pathology – Medical Policy & Operations
| Company | CVS Health |
|---|---|
| Location | New Mexico, USA, Washington, USA, Kansas, USA, Pennsylvania, USA, North Dakota, USA, Oregon, USA, Delaware, USA, Vermont, USA, Wyoming, USA, Texas, USA, Montana, USA, Jackson Township, NJ, USA, Waterbury, CT, USA, Nevada, USA, South Carolina, USA, South Dakota, USA, Georgia, USA, Concord, NH, USA, Mississippi, USA, Tennessee, USA, Virginia, USA, Minnesota, USA, Rhode Island, USA, Utah, USA, Northeastern United States, USA, Kentucky, USA, West Virginia, USA, New York, NY, USA, Maryland, USA, Wisconsin, USA, Maine, USA, Massachusetts, USA, North Carolina, USA, Oklahoma, USA, Missouri, USA, Ohio, USA, Louisiana, USA, Michigan, USA, Illinois, USA, United States |
| Salary | $174070 – $374920 |
| Type | Full-Time |
| Degrees | MD |
| Experience Level | Senior |
Requirements
- Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and current state medical license without encumbrances.
- M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience.
Responsibilities
- Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services.
- Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests.
- Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services.
- Be a subject matter expert, internal consultant and payment policy contributor subject matter expertise and internal consultant.
- Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company.
- Work Collaboratively with the functional areas.
Preferred Qualifications
- Health plan/payor experience.
- Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems.
- Experience in Molecular pathology / Genetic reviews in the Commercial and Medicare environment.
- Strong communication skills both written and verbal.