Medical Director - Medical Policy & Operations

5 days ago

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CVS Health

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Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+

Description

• Provide clinical expertise and business direction in medical management programs • Support the appeal process and claim review • Use data analysis to identify quality improvement opportunities • Participate in work groups as a clinical subject matter expert • Collaborate with functional areas to manage business objectives

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 • Health plan/payor experience (preferred) • Strong communication skills both written and verbal (preferred)

Benefits

• Full range of medical, dental, and vision benefits • 401(k) retirement savings plan • Employee Stock Purchase Plan • Fully-paid term life insurance • Short-term and long-term disability benefits • Well-being programs • Education assistance • Free development courses • CVS store discount • Paid Time Off (PTO) or vacation pay • Paid holidays