Medical Director - National Accounts

November 7

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CVS Health

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

10,000+

Description

• Provide oversight for medical policy implementation. • Participate in development, implementation, and evaluation of clinical/medical programs. • Expand Aetna's medical management programs to address member needs. • Support Medical Management staff ensuring timely responses to members and providers. • Oversee utilization review/quality assurance, directing case management. • Provide clinical expertise and business direction in support of medical management programs. • Act as lead business and clinical liaison to network providers and facilities. • Provide clinical, coding, and reimbursement expertise for predetermination reviews and claim determinations.

Requirements

• 2 or more years of experience in Health Care Delivery System. • Active and current state medical license without encumbrances. • M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience. • Health plan/payor experience preferred. • Electronic medical systems/record experience preferred. • Managed Care experience preferred.

Benefits

• Full range of medical, dental, and vision benefits. • 401(k) retirement savings plan. • Employee Stock Purchase Plan. • Fully-paid term life insurance plan. • Short-term and long term disability benefits. • Well-being programs, education assistance, free development courses. • CVS store discount, and discount programs with partners. • Paid Time Off (PTO) and paid holidays throughout the year.