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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

Connecticut

Posted

4 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 subject matter expertise and internal consultant. • 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.
  • Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems.
  • Strong communication skills both written and verbal.

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

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