Remote Medical Director, Health Plan Policy & Care Mgmt

CVS Health; Iowa; Hybrid; USD 174,000 - 375,000; Full time

Job summary

CVS Health, in partnership with Aetna, seeks a Medical Director to oversee medical policy and management programs. This remote role requires an active MD/DO license and board certification, with focus on utilization review and quality assurance across the continuum of care.

Ideal candidates will have 5+ years in healthcare delivery, coordinate with network providers, and support clinical teams. CVS Health offers a comprehensive benefits package and equity opportunities.

Qualifications

• Five or more years of experience in Health Care Delivery System (clinical practice and health care industry).
• Active and current medical license (M.D. or D.O.) without encumbrances; board certification in an ABMS or AOA specialty.

Responsibilities

• Oversee utilization review and quality assurance; predetermination reviews and review of claim determinations.
• Provide clinical, coding, and reimbursement expertise; direct case management when necessary.
• Lead liaison to network providers and facilities to support medical services programs by clinical teams.

Skills

Medical license

Board certification

Clinical practice

Healthcare policy understanding

Education

Medical Doctor or DO

Job description

CVS Health, in partnership with Aetna, seeks a Medical Director to oversee medical policy and management programs. This remote role requires an active MD/DO license and board certification, with focus on utilization review and quality assurance across the continuum of care.

Ideal candidates will have 5+ years in healthcare delivery, coordinate with network providers, and support clinical teams. CVS Health offers a comprehensive benefits package and equity opportunities.