[Remote] Case Management Medical Director at CVS Health

Connecticut, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Active and current medical license (MD or DO) without encumbrances
Board Certification including Maintenance of Certification in Family Practice, Internal Medicine, or Geriatrics
Post-graduate 5 years of direct patient care experience
3-5 years of Managed Care experience; Medicare highly preferred
3-5 year of Case Management experience
Ability to work effectively in a highly matrixed organization / environment
Ability to engage at all levels, including physicians, vendors, community partners, administrative leaders, clinical leaders and staff
Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm
Ability to travel to Provider, Member Meetings as indicated
Flexibility with work schedule to meet business needs

Responsibilities

Provides clinical oversight of the case management teams and the Interdisciplinary Care Team (ICT) processes by participating in the development of members’ Individual Care Plans (ICP) and assisting case management staff as they support of members’ physical, behavioral and socioeconomic needs
Provides clinical guidance for Long Stay, Palliative Care, Transition of Care and/or other CM clinical initiatives/rounds
Contributes to strategies, tactics and programs for case management and community engagement of members, community partners and providers to create unique local strategies as needed
Leverages available clinical platforms for case review; i.e. EPIC Everywhere
Provides clinical guidance and leadership to CM & clinical team colleagues (SW & Pharmacy)
Collaborates with the Learning and Performance Team to develop clinical training for case management staff such as 5 ‘Clinical Pearls’ ppt presentations yearly
Provides CM NP with guidance and oversight on Clinical rounds case prep, case selection, provider & member outreach when warranted
Provides clinical review and adjudication of MCR Appeals case when needed
Oversees and manages 1 Regional CM initiative in collaboration and guidance of CM SMD
Ensures timely execution of all deliverables in accordance with due dates and Federal/state regulatory requirements
Travel to Provider, Member Meetings as indicated
Ensures member safety and quality of care delivery

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

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 in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

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

Risks

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.

Differentiation

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.

Upsides

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.

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