Medical Director (Medical Policy & Operations), CVS Health

CVS Health

Location:
United States

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

In this role as Medical Director MPO (Medical Policy & Operations), you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This Medical Director provides subject matter expertise to provide clinical support and business direction in these areas.

Job Responsibility:

Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services
Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services
Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant
Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company
Work Collaboratively with the functional areas

Requirements:

Five (5) 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 an ABMS recognized specialty including post-graduate direct patient care experience

Nice to have:

Health plan/payor experience
Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS/CPT, Clinical Policy, Reimbursement and Health Care Systems
Strong communication skills both written and verbal

What we offer:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and 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

Additional Information:

Job Posted:
March 19, 2025

Expiration:
April 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director (Medical Policy & Operations)