Remote Radiation Oncology Medical Director | Policy & Utilization Lead

World Oncology Network; Northern (KY); Hybrid; USD 174,000 - 375,000; Full time

Job summary

CVS Health is seeking a Radiation Oncology Medical Director to support the Specialty oncology business, providing clinical, coding, and reimbursement expertise and directing case management when needed. The role involves overseeing utilization review, quality assurance, predetermination reviews, and review of claim determinations, with involvement in medical policy implementation and program development.

This is a remote, full-time exempt position with typical hours 9:00-6:00 ET and occasional

Qualifications

• MD or DO with current, active U.S. state medical license in good standing.
• Board certified in Radiation Oncology by ABMS or AOA.
• Eligible for additional state licensure as required.
• 3+ years of Radiation Oncology experience in patient care or managed care.
• Ability to travel 1-2 times per quarter.

Responsibilities

• Support Oncology initiatives across the enterprise.
• Oversee utilization review and quality assurance; predetermination reviews and review of claim determinations; provide input for medical policy implementation.
• Participate in Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
• Provide clinical, coding, and reimbursement expertise; direct case management when necessary.
• Participate in development, implementation, and evaluation of clinical/medical programs and expand medical management programs.
• Support Medical Management staff ensuring timely responses to members and providers.
• Provide clinical expertise and business direction in support of medical management programs through clinical team activities.
• Act as a business and clinical liaison to network providers and facilities to support medical services programs by clinical teams.
• Participate in a weekend, holiday and on-call rotation.

Skills

Radiation Oncology experience

Travel ability

Medical license & board certification

Education

Medical Doctor or Doctor of Osteopathic Medicine

Job description

CVS Health is seeking a Radiation Oncology Medical Director to support the Specialty oncology business, providing clinical, coding, and reimbursement expertise and directing case management when needed. The role involves overseeing utilization review, quality assurance, predetermination reviews, and review of claim determinations, with involvement in medical policy implementation and program development.

This is a remote, full-time exempt position with typical hours 9:00-6:00 ET and occasional