Remote Medical Director: Utilization & Policy Oversight

CVS Health Corporation; Pennsylvania; Ibrido; USD 174.000 - 375.000; Tempo pieno

Vantaggi offerti da questo lavoro

Bonus program

Comprehensive benefits

Remote work

Descrizione del lavoro

CVS Health Corporation seeks a Medical Director to oversee medical policy implementation and support medical management programs across the care continuum. This remote role preferably resides in PA/DE/WV and requires an active state medical license.

You will lead utilization review, quality assurance, and predetermination reviews, while supporting prior authorizations, peer-to-peer calls, and special projects; you will guide case management and serve as a clinical liaison to network providers.

Competenze

• MD or DO with ABMS/AOA board certification and post-graduate direct patient care experience.
• Active and current state medical license.
• Preferred: active license in PA/WV/DE without encumbrances.

Mansioni

• Oversee utilization review and quality assurance activities within medical management.
• Lead predetermination reviews and prior authorization processes.
• Contribute clinical expertise and direction to medical management programs across the continuum of care.
• Act as a clinical liaison to network providers and facilities to support medical services programs.

Conoscenze

Medical license

UM experience

Formazione

MD or DO

ABMS/AOA Board Certification

Descrizione del lavoro

CVS Health Corporation seeks a Medical Director to oversee medical policy implementation and support medical management programs across the care continuum. This remote role preferably resides in PA/DE/WV and requires an active state medical license.

You will lead utilization review, quality assurance, and predetermination reviews, while supporting prior authorizations, peer-to-peer calls, and special projects; you will guide case management and serve as a clinical liaison to network providers.