CVS Health

Medical Director - New England Region

CVS Health

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $174,070 - $374,920 per year

Job Level

Lead

About the role

  • This is a remote based (work from home) position for the New England Region.
  • The preferred candidate will reside in Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine.
  • The Medical Director will be responsible for overseeing the utilization review for health systems and providers in New England.
  • An ideal candidate would have experience performing in-hospital utilization reviews and other quality activities.
  • The Medical Director will be required to have a New England state medical license without encumbrances, or the ability to obtain the license within a reasonable timeframe.
  • Collaboration and teamwork are the defining characteristics of The New England Medical Director team; in order to be a successful member of the team the candidate must exemplify these qualities.
  • As a Medical Director you will focus primarily on overseeing utilization review and quality assurance of inpatient hospitalizations, prior authorizations, and appeals.
  • You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
  • You will support the Medical Management staff ensuring timely and consistent responses to members and providers.
  • This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.

Requirements

  • Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry
  • Active and current medical license without encumbrances
  • M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience
  • Residence in one of the states in the New England Region
  • Previous UM experience with a Health Plan / Payor.
  • Previous UM experience as a Physician Advisor in a Health / Hospital system.
  • Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine