Medical Director - ENT at CVS Health Sacramento, CA

Itlearn360; Sacramento (CA); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading health solutions company is seeking a Medical Director (ENT) to lead utilization review and quality assurance. This remote position requires a strong background in Otolaryngology with at least 2 years of experience in healthcare delivery. The role offers a salary range of $174,070 - $374,920, along with comprehensive benefits and opportunities for professional development.

Benefits

Medical plans

401(k)

Employee stock purchase plan

Wellness programs

Paid time off

Flexible schedules

Qualifications

• At least 2 years of experience in healthcare delivery or related fields.
• Active, current state medical license without encumbrances.
• Post-graduate clinical experience.

Responsibilities

• Lead all aspects of utilization review and quality assurance.
• Support medical management programs and clinical team activities.
• Serve as a liaison to network providers and facilities.

Skills

Healthcare delivery

Clinical expertise

Reimbursement knowledge

Education

MD or DO degree

Board Certification in Otolaryngology

Job description

Medical Director - ENT Job at CVS Health, Sacramento, CA

Job Description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues — caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. We do it all with heart, each and every day.

Job Summary

Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. This provides a unique opportunity to help transform health care. We believe in a transparent, consumer-focused care system that recognizes physicians for their clinical quality and effective use of resources.

This is a remote, work-from-home position anywhere in the US.

Position Overview

The Medical Director (ENT) will be a Subject Matter Expert (SME) with a background in Otolaryngology, including post-graduate direct patient care experience. The role involves expanding medical management programs, supporting medical staff, leading utilization review and quality assurance, and acting as a clinical liaison to providers and facilities.

Responsibilities

1. Lead all aspects of utilization review and quality assurance.
2. Support medical management programs and clinical team activities.
3. Serve as a liaison to network providers and facilities.
4. Conduct predetermination reviews and claim reviews, providing clinical, coding, and reimbursement expertise.

Qualifications

• At least 2 years of experience in healthcare delivery or related fields.
• Active, current state medical license without encumbrances.
• MD or DO degree, Board Certification in Otolaryngology, with post-graduate clinical experience.

Preferred Qualifications

• Previous utilization management experience with a health plan or payor.

Compensation and Benefits

The pay range is $174,070 - $374,920 annually, depending on experience, education, and location. Benefits include medical plans, 401(k), employee stock purchase plan, wellness programs, paid time off, flexible schedules, and more.

Application Details

The application window closes on 07/31/2025. CVS Health is an equal opportunity employer, considering qualified applicants regardless of protected characteristics.