Remote Medical Director - Health Policy & Utilization

CVS Health Corporation; Northern (KY); Hybride; USD 174 000 - 375 000; Plein temps

Résumé du poste

CVS Health Corporation is seeking a Medical Director for remote work, preferably based in PA/DE/WV, with an active US medical license. The role focuses on medical policy implementation, oversight of utilization review, and support for medical management programs across the care continuum.

The position requires an MD or DO with board certification and experience in health plan UM. The successful candidate will collaborate with clinical teams and network providers to improve care quality and

Qualifications

• MD or DO with board certification and active medical license.
• Experience with UM programs in health plans preferred.

Responsabilités

• Oversee medical policy implementation and program evaluation.
• Lead utilization review, QA, and predetermination reviews including PA/pre-certification.
• Support Medical Management staff with timely responses to providers and members.
• Serve as liaison to network providers to facilitate medical services programs.
• Lead or participate in clinical teams and special projects as needed.

Connaissances

Medical policy oversight

Clinical leadership

Utilization management

Peer to peer communications

Prior Authorization / PreCertification

Formation

MD or DO

Description du poste

CVS Health Corporation is seeking a Medical Director for remote work, preferably based in PA/DE/WV, with an active US medical license. The role focuses on medical policy implementation, oversight of utilization review, and support for medical management programs across the care continuum.

The position requires an MD or DO with board certification and experience in health plan UM. The successful candidate will collaborate with clinical teams and network providers to improve care quality and