CVS Health
Bringing our heart to every moment of your health.
Medical Director – Medical Policy, Operations
Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn
Location
Idaho + 2 moreAll locations: Idaho, Montana, Texas
Posted
36 days ago
Salary
$174.1K - $374.9K / year
Seniority
Lead
Postgraduate Degree5 yrs expEnglish
Job Description
• Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services
• Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
• Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services
• Be a subject matter expert, internal consultant and payment policy contributor
• Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company
• Work Collaboratively with the functional areas
Job 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)
- Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems (Preferred)
- Strong communication skills both written and verbal (Preferred)
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access and many other benefits depending on eligibility
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