Remote Medical Director, Policy & Operations

CVS Health; Hartford (CT); À distance; USD 174 000 - 375 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Bonus/commission eligibility

Equity award program

Résumé du poste

CVS Health is seeking a Medical Director MPO (Medical Policy & Operations) to provide clinical leadership from a remote position anywhere in the United States. The role focuses on policy, clinical review, and payment decisions to support high-quality care for Commercial and Medicare populations.

Responsibilities include handling appeals, claim reviews, and predetermination of benefits, with strong emphasis on coding policy, reimbursement, and performance analytics. Aetna experience is preferred.

Qualifications

• MD or DO and active state medical license
• 5+ years in Health Care Delivery System (clinical practice and health care industry)
• 1+ year experience in a health insurance company
• Foundational knowledge in medical policy, coding (HCPCS/CPT) and reimbursements

Responsabilités

• Provide clinical expertise to promote high-quality, constituent-focused medical care and policy
• Review transactions to support appeals and predetermination of benefits in Commercial and Medicare environments
• Lead or participate in cross-functional work groups to improve care quality and efficiency
• Apply clinical coding and reimbursement knowledge to ensure alignment with Aetna policies
• Collaborate with health delivery professionals to meet business objectives

Connaissances

Clinical experience

Health insurance knowledge

Strong communication

Team collaboration

Formation

MD or DO

Board Certification in ABMS specialty

Description du poste

CVS Health is seeking a Medical Director MPO (Medical Policy & Operations) to provide clinical leadership from a remote position anywhere in the United States. The role focuses on policy, clinical review, and payment decisions to support high-quality care for Commercial and Medicare populations.

Responsibilities include handling appeals, claim reviews, and predetermination of benefits, with strong emphasis on coding policy, reimbursement, and performance analytics. Aetna experience is preferred.