Remote Medical Director, Health Policy & Utilization

9025 CVS Shared Services Resources LLC; Pennsylvania; Hybrid; USD 174,000 - 375,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health, through its Aetna division, seeks a Medical Director for remote-based work from home. This role oversees medical policy implementation, supports clinical programs, and directs utilization review with predetermination reviews.

Preference for candidates in PA/DE/WV with an active medical license and ABMS/AOA board certification. Responsibilities include leading case management, coordinating with networks, and driving clinical program efficiency.

Qualifications

• MD or DO with board certification in an ABMS or AOA recognized specialty.
• Active and current state medical license.
• Post-graduate direct patient care experience.

Responsibilities

• Oversee medical policy implementation.
• Participate in development, implementation and evaluation of clinical programs.
• Oversee utilization review, quality assurance and predetermination reviews.
• Lead case management and peer-to-peer processes when needed.

Skills

Active medical license

Board Certification

Policy oversight

Education

MD or DO

Job description

CVS Health, through its Aetna division, seeks a Medical Director for remote-based work from home. This role oversees medical policy implementation, supports clinical programs, and directs utilization review with predetermination reviews.

Preference for candidates in PA/DE/WV with an active medical license and ABMS/AOA board certification. Responsibilities include leading case management, coordinating with networks, and driving clinical program efficiency.