Medical Director - Commercial
Description:
• This is a remote based (work from home) role and can be based anywhere in the US.
• You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's 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.
• This includes Prior Authorization/Pre-Certification/Concurrent Reviews/Peer to Peer calls/First Level Appeals/Special Projects and Committee participation when needed.
• You will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Requirements:
• 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
• Five or more years of direct patient care experience
• Previous UM experience with a Health plan/payor experience.
• Electronic medical systems/record experience
• Managed Care experience
• Board certification in Internal Medicine, Family Medicine, Emergency Medicine, OB/GYN or Med/PM&R
Benefits:
• Affordable medical plan options
• a 401(k) plan (including matching company contributions)
• an employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
• For more information, visit https://jobs.cvshealth.com/us/en/benefits
Apply Now
Apply Now
• This is a remote based (work from home) role and can be based anywhere in the US.
• You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's 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.
• This includes Prior Authorization/Pre-Certification/Concurrent Reviews/Peer to Peer calls/First Level Appeals/Special Projects and Committee participation when needed.
• You will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Requirements:
• 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.
• Five or more years of direct patient care experience
• Previous UM experience with a Health plan/payor experience.
• Electronic medical systems/record experience
• Managed Care experience
• Board certification in Internal Medicine, Family Medicine, Emergency Medicine, OB/GYN or Med/PM&R
Benefits:
• Affordable medical plan options
• a 401(k) plan (including matching company contributions)
• an employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
• For more information, visit https://jobs.cvshealth.com/us/en/benefits
Apply Now
Apply Now