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Medical Director
| Company | CVS Health |
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| Location | Ohio, USA |
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| Salary | $174070 – $374920 |
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| Type | Full-Time |
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| Degrees | MD |
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| Experience Level | Senior |
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Requirements
- Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and current medical license without encumbrances
- M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
Responsibilities
- Provide oversight for medical policy implementation.
- Participate in the development, implementation, and evaluation of clinical / medical programs.
- Support the Medical Management staff ensuring timely and consistent responses to members and providers.
- Focus primarily on overseeing utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations.
- Provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
- Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs.
Preferred Qualifications
- Previous UM experience with a Health Plan / Payor.
- Previous UM experience as a Physician Advisor in a Health / Hospital system.
- Board Certification in Internal Medicine, Family Medicine, Emergency Medicine or Med / Peds Preferred.
