Remote Medical Director: Policy & Utilization Leader

CVS Health Corporation; Harrisburg (Dauphin County); Remote; USD 174,000 - 375,000; Full time

Job summary

CVS Health Corporation, through Aetna, offers a remote-based Medical Director role preferably residing in PA/DE/WV. You will oversee medical policy implementation and participate in developing and evaluating clinical programs to improve member care across the continuum.

The position requires an MD or DO with active state licensure and ABMS/AOA board certification, plus experience in utilization management. Remote work from home with comprehensive benefits and potential incentive programs.

Qualifications

• MD or DO with ABMS/AOA board certification and post-graduate direct patient care.
• Active and current state medical license is required.
• Preferred: active license in PA/WV/DE and prior UM experience with a health plan.

Responsibilities

• Provide oversight for medical policy implementation and evaluation of clinical programs.
• Oversee utilization review, quality assurance, predetermination reviews (PA, pre-certification, concurrent reviews).
• Lead case management direction and act as liaison to network providers and facilities.

Education

MD or DO

Job description

CVS Health Corporation, through Aetna, offers a remote-based Medical Director role preferably residing in PA/DE/WV. You will oversee medical policy implementation and participate in developing and evaluating clinical programs to improve member care across the continuum.

The position requires an MD or DO with active state licensure and ABMS/AOA board certification, plus experience in utilization management. Remote work from home with comprehensive benefits and potential incentive programs.