Remote Radiation Oncology Medical Director — Utilization & Policy Leader

ISHE; Phoenix (AZ); Hybrid; USD 174,000 - 375,000; Full time

Benefits offered by this job

Bonus eligibility

Equity program

Comprehensive benefits

Job summary

CVS Health is hiring a Radiation Oncology Medical Director to oversee oncology utilization, policy implementation, and review processes in a remote, home-based role. The position supports the enterprise oncology initiatives with emphasis on prior authorization, peer-to-peer reviews, and case management.

The role requires MD/DO, board certification in Radiation Oncology, and 3+ years of relevant experience, with travel 1-2 times per quarter.

Qualifications

• MD or DO with an active U.S. state medical license in good standing.
• Board certification in Radiation Oncology by ABMS or AOA.
• Eligible for additional state licensure as required.
• 3+ years of radiation oncology experience post residency.
• Ability to travel 1-2 times/quarter for meetings.

Responsibilities

• Oversee utilization review and quality assurance for oncology programs.
• Provide input for medical policy implementation and prior authorization processes.
• Manage predetermination reviews, claim determinations, and peer-to-peer reviews.
• Direct medical management activities and participate in clinical program development.
• Support timely responses to members and providers and coordinate with clinical teams.

Skills

Radiation Oncology expertise

Policy & case management

Clinical reimbursement

Travel readiness

Education

MD/DO

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary
The Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.

This is a remote based (work from home) position

• One may live anywhere in the United States
• This is a full-time/exempt-level position, and the hours will typically be around the framework of 9:00-6:00 Eastern Time
• Travel for team meetings and client-facing meetings could happen 1-2 times/quarter

In this role you will:

• Support Oncology initiatives throughout the enterprise
• As a Medical Director you will focus primarily on overseeing utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations, In the Medical Director role you will provide input for medical policy implementation.
• This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
• The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
• You will participate in the development, implementation, and evaluation of clinical / medical programs and expand medical management programs to address member needs across the continuum of care.
• You will support the Medical Management staff ensuring timely and consistent responses to members and providers.
• In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• The Medical Director will act as a business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
• Participate in a weekend, holiday and on-call rotation.

Required Qualifications

• M.D. or D.O. with a current, active, U.S. state medical license that is in good standing
• Board certified inRadiation Oncology, recognized by the American Board of Medical Specialties, or American Osteopathic Association
• Eligible to acquire additional state licensureas required
• 3+ years of relevant radiation oncology experience in a patient care, or managed care setting post residency
• Ability to travel 1-2 times/quarter for team, or client-facing meetings

Preferred Qualifications

• Previous UM experience with a Health Plan / Payor.
• Previous UM experience as a Physician Advisor in a Health / Hospital system.

Education

• Medical Doctor or Doctor of Osteopathic Medicine

Pay Range
The typical pay range for this role is:

$174,070.00 - $374,920.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.