Full-Time

Medical Director Aetna Duals Center of Excellence

Confirmed live in the last 24 hours

CVS Health

CVS Health

10,001+ employees

Comprehensive pharmacy and healthcare services

Healthcare
Consumer Goods

Compensation Overview

$174.1k - $374.9kAnnually

+ Bonus + Commission + Equity Awards

Senior

Company Historically Provides H1B Sponsorship

Remote in USA

Work-at-home position located anywhere in the US.

Category
Physicians & Surgeons
Medical, Clinical & Veterinary

You match the following CVS Health's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • Minimum 3-5 years of clinical practice experience.
  • Two (2) + years of experience in managed care (Medicare and/or Medicaid)
  • MD or DO; Board certification in an ABMS or AOA recognized specialty is required.
  • Active and current state medical license without encumbrances is required. Multiple state licensure a plus.
Responsibilities
  • Utilization management – The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials.
  • Appeals – The medical director will perform appeals in their 'base plan' and in the round robin based on 'same or similar specialty' needs.
  • Pharmacy coverage – The medical director will perform pharmacy reviews.
  • The medical director will participate in and be able to lead daily rounds.
Desired Qualifications
  • Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System.
  • Licensed in or willing to obtain license in at least one state where we have an Integrated plan.

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals on their journey to better health.

Company Stage

Debt Financing

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

1963

Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion of telehealth services allows CVS to reach more patients remotely.
  • Increased consumer interest in wellness boosts demand for CVS's health-related products.
  • The trend towards value-based care aligns with CVS's integrated healthcare approach.

What critics are saying

  • Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
  • The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
  • The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

What makes CVS Health unique

  • CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
  • The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
  • CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays