[Hiring] Medical Director - Radiation Oncology @CVS Health

Role Description

The Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.

This is a remote based (work from home) position. One may live anywhere in the United States. This is a full-time/exempt-level position, and the hours will typically be around the framework of 9:00-6:00 Eastern Time. Travel for team meetings and client-facing meetings could happen 1-2 times/quarter.

In this role you will:

• Support Oncology initiatives throughout the enterprise.
• Focus primarily on overseeing utilization review and quality assurance.
• Be responsible for predetermination reviews and review of claim determinations.
• Provide input for medical policy implementation.
• Engage in Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
• Provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
• Participate in the development, implementation, and evaluation of clinical / medical programs.
• Expand medical management programs to address member needs across the continuum of care.
• Support the Medical Management staff ensuring timely and consistent responses to members and providers.
• Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• Act as a business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
• Participate in a weekend, holiday and on-call rotation.

Qualifications

• M.D. or D.O. with a current, active, U.S. state medical license that is in good standing.
• Board certified in Radiation Oncology, recognized by the American Board of Medical Specialties, or American Osteopathic Association.
• Eligible to acquire additional state licensure as required.
• 3+ years of relevant radiation oncology experience in a patient care, or managed care setting post residency.
• Ability to travel 1-2 times/quarter for team, or client-facing meetings.

Preferred Qualifications

• Previous UM experience with a Health Plan / Payor.
• Previous UM experience as a Physician Advisor in a Health / Hospital system.

Education

• Medical Doctor or 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

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.