Remote Medical Director, Policy & Operations

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

Benefits offered by this job

Medical coverage

Dental & Vision

Paid time off

Retirement savings

Job summary

Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director MPO (Medical Policy & Operations). This remote work-at-home position can be located anywhere in the United States.

You will provide clinical expertise to promote high-quality, constituent-focused medical care with a focus on clinical and payment policy. The role includes transactional reviews for appeals, clinical claim reviews, and predetermination of covered benefits in Commercial and Medicare environments.

Qualifications

• Five or more years of experience in Health Care Delivery System.
• Active and current state medical license without encumbrances.
• MD or DO with ABMS board certification and post-graduate direct patient care experience.

Responsibilities

• Transactional reviews to support the appeal process.
• Clinical claim review and predetermination of benefits for Commercial and Medicare.
• Apply clinical coding and reimbursement knowledge to ensure policy alignment.
• Lead and collaborate with teams across health delivery professionals.

Skills

Health care delivery experience

Clinical expertise

Policy understanding

Education

MD or DO

Job description

Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director MPO (Medical Policy & Operations). This remote work-at-home position can be located anywhere in the United States.

You will provide clinical expertise to promote high-quality, constituent-focused medical care with a focus on clinical and payment policy. The role includes transactional reviews for appeals, clinical claim reviews, and predetermination of covered benefits in Commercial and Medicare environments.