[Remote] Medical Director (South Central Market) at CVS Health

United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry
Active and current Texas state medical license without encumbrances
M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience
Preferred Qualifications: Previous UM experience with a Health Plan / Payor
Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, OB / GYN or Med / PM&R
Education: M.D. or D.O

Responsibilities

Provide oversight for medical policy implementation
Participate in the development, implementation, and evaluation of clinical / medical programs
Expand Aetna's medical management programs to address member needs across the continuum of care
Support the Medical Management staff ensuring timely and consistent responses to members and providers
Focus primarily on overseeing utilization review / quality assurance and predetermination reviews
Provide clinical, coding, and reimbursement expertise
Direct case management when necessary
Act as lead business and clinical liaison to network providers and facilities
Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities
Participate in clinical team activities
Lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams

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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