Remote Medical Director, Policy & DRG Operations

CVS Health; United States; Remoto; USD 174.000 - 375.000; Tempo pieno

Vantaggi offerti da questo lavoro

Comprehensive benefits package

Bonus eligibility

Retirement savings options

Descrizione del lavoro

CVS Health is seeking a Medical Director MPO to provide clinical policy and operations leadership nationwide from a remote location in the United States. The role focuses on transactional reviews for appeals, clinical claim reviews, and predetermination of benefits within Commercial and Medicare, leveraging DRG reviews, coding, and policy expertise to improve care and payment processes.

Requirements include an active MD/DO license, ABMS board certification, and 5+ years in health care delivery;

Competenze

• Five or more years of experience in Health Care Delivery System.
• Active and current state medical license without encumbrances.
• M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience

Mansioni

• Review transactions to support the appeal process and predetermination of covered benefits in Commercial and Medicare environments.
• Apply clinical coding and reimbursement expertise to ensure alignment and correct application of policies and practices.
• Proactively use data analysis to identify opportunities for quality improvement and influence delivery of quality care services.
• Be a subject matter expert and payment policy contributor.
• Demonstrate ability to lead diverse teams to meet business objectives.

Conoscenze

Strong communication

DRG reviews

Data analysis

Coding (HCPCS/CPT)

Formazione

M.D. or D.O.

Board Certification in ABMS specialty

Descrizione del lavoro

CVS Health is seeking a Medical Director MPO to provide clinical policy and operations leadership nationwide from a remote location in the United States. The role focuses on transactional reviews for appeals, clinical claim reviews, and predetermination of benefits within Commercial and Medicare, leveraging DRG reviews, coding, and policy expertise to improve care and payment processes.

Requirements include an active MD/DO license, ABMS board certification, and 5+ years in health care delivery;