Remote Radiation Oncology Medical Director

CVS Health

Illinois

Hybrid

USD 174,000 - 375,000

Full time

4 days ago

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Benefits offered by this job

Bonus program

Equity awards

Comprehensive benefits

Job summary

CVS Health is seeking a Radiation Oncology Medical Director for a remote-based role supporting the Specialty oncology business in utilization management, clinical policy, and case reviews. You will provide leadership in predetermination reviews, coding, and reimbursement expertise, while guiding case management as needed.

The position requires M.D. or D.O., board certification in Radiation Oncology, and active US licensure, with travel 1-2 times per quarter.

Qualifications

Board certification in Radiation Oncology or ABMS/AOA recognized.
Active, current US state medical license in good standing.
Eligibility to acquire additional state licensure as required.

Responsibilities

Support oncology initiatives across the enterprise.
Oversee utilization review and quality assurance; predetermination reviews and claim determinations.
Provide input for medical policy implementation and clinical program development.
Participate in prior authorization, pre-certification, concurrent reviews, peer-to-peer calls and appeals.
Act as clinical, coding, and reimbursement expert; direct case management when needed.
Collaborate with medical management teams to address member needs across care continuum.
Engage with network providers and facilities to execute medical services programs.