Medical Director - SWAT

October 4

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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. • Develop, implement, and evaluate clinical/medical programs. • Expand Aetna's medical management programs to address member needs. • Support Medical Management staff for timely responses. • Oversee utilization review/quality assurance. • Provide clinical expertise and business direction in medical management programs. • Act as liaison to network providers and facilities. • Responsible for predetermination reviews and claim determinations.

Requirements

• 2 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 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 • 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 throughout the calendar year