Medical Director - SWAT

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
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

**This is a fully remote, work from home role.**

In the Medical Director role you will provide oversight for medical policy implementation. You'll 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. In addition you will oversee utilization review/quality assurance, directing case management   In this role you'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities and 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. 

You'll be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

Required Qualifications
*2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
*Active and current state medical license without encumbrances
*M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.

Preferred Qualifications
*Health plan/payor experience.
*Electronic medical systems/record experience
*Managed Care experience

Education
*M.D. or D.O., Board Certification in a recognized ABMS or AOA specialty including post-graduate direct patient care experience

Pay Range

The typical pay range for this role is:

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.

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.