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CVS Health

Bringing our heart to every moment of your health.

Medical Director – Aetna Duals Center of Excellence

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Illinois + 3 moreAll locations: Illinois, Oklahoma, Mississippi, Texas

Posted

44 days ago

Salary

$174.1K - $374.9K / year

Seniority

Lead

Postgraduate Degree3 yrs expEnglish

Job Description

• The Medical Director will support the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. • Perform concurrent and prior authorization reviews with peer to peer coverage of denials. • Perform appeals in their "base plans" and may round robin based on "same or similar specialty" needs. • Conduct pharmacy reviews. • Participate in and lead rounds.

Job Requirements

  • Minimum 3-5 years of clinical practice experience
  • Two (2) + years of experience in managed care (Medicare and/or Medicaid)
  • Experience with managed care (Medicare and Medicaid) utilization review preferred
  • 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

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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