Remote Medical Director - Utilization and Quality Oversight

CVS Health; Illinois; Hybrid; USD 174,000 - 375,000; Full time

Benefits offered by this job

Bonus opportunities

Equity award program

Comprehensive benefits

Job summary

Aetna, a CVS Health Company, is seeking a Medical Director to oversee medical policy implementation and support clinical management programs for members and providers. This remote-based role allows you to work from home while aligning with CVS Health's mission to deliver transparent, high-quality care.

Ideal candidates hold MD/DO with board certification, a current medical license, and 5+ years in health care delivery, with experience in utilization review, quality assurance, and

Qualifications

• Active and current medical license without encumbrances.
• MD or DO with ABMS or AOA board certification including post-graduate direct patient care experience.

Responsibilities

• Provide oversight for medical policy implementation.
• Develop, implement, and evaluate clinical/medical programs and expand medical management programs.
• Support Medical Management staff ensuring timely and consistent responses to members and providers.
• Oversee utilization review and quality assurance and predetermination reviews and review of claim determinations.
• Lead Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation.

Skills

Medical licensing

Education

MD or DO

Job description

Aetna, a CVS Health Company, is seeking a Medical Director to oversee medical policy implementation and support clinical management programs for members and providers. This remote-based role allows you to work from home while aligning with CVS Health's mission to deliver transparent, high-quality care.

Ideal candidates hold MD/DO with board certification, a current medical license, and 5+ years in health care delivery, with experience in utilization review, quality assurance, and