[Hiring] Medical Director @CVS Health

Role Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Aetna Duals Center of Excellence (COE) operates Duals Integrated Plans in Illinois, Michigan, Virginia, Florida, and New Jersey offering a variety of physical and behavioral health programs and services to its membership.

Aetna is looking for a Medical Director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. The Medical Director is a work-at-home position located anywhere in the US.

The Medical Director will work a full-time schedule Monday to Friday. The Medical Director can work from any state but will be required to work Eastern Standard Time or Central Standard Time 8:00 AM - 5:00 PM. The Medical Director will also be expected to work 1 holiday and 8 weekend days (approximately 1 weekend per quarter) each year.

Fundamental Components:

• Utilization management – The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• Appeals – The medical director will perform appeals in their “base plans” and may round robin based on “same or similar specialty” needs.
• Pharmacy coverage – The medical director will perform pharmacy reviews.
• The medical director will participate in and be able to lead rounds.

Qualifications

• Minimum 3-5 years of clinical practice experience.
• Two (2) + years of experience in managed care (Medicare and/or Medicaid).
• Experience with utilization management (preferred Medicare and/or Medicaid).
• MD or DO; Board certification in an ABMS or AOA recognized specialty is required.
• Active and current state medical license without encumbrances is required. Multiple state licensure a plus.
• Florida license or ability to obtain.

Preferred Qualifications

• Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System.
• Licensed in or willing to obtain license in at least one state where we have an Integrated plan.

Education

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).

Pay Range

The typical pay range for this role is: $174,070.00 - $374,920.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.