[Remote] Medical Director -Spine at CVS Health

Connecticut, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

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 Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically

Responsibilities

Expands Aetna's medical management programs to address member needs across the continuum of care
Supports the Medical Management staff ensuring timely and consistent responses to members and providers
Leads all aspects of utilization review/quality assurance, directing case management
Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities
Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams
Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer based applications

Skills

Key technologies and capabilities for this role

Orthopedic SpineNeurosurgeryUtilization ReviewQuality AssuranceCase ManagementMedical ManagementPredetermination ReviewsClaim Reviews

Questions & Answers

Common questions about this position

What is the pay range for the Medical Director - Spine position?

The typical pay range for this role is $174,070.00 - $374,920.00.

Is this Medical Director - Spine role remote?

Yes, this is a remote based (work at home) position anywhere in the US.

What are the required qualifications for this role?

Candidates must have 2 or more years of experience in Health Care Delivery System (e.g., Clinical Practice and Health Care Industry), an active and current state medical license without encumbrances, and be an M.D. or D.O. with Board Certification in Orthopedic Spine or Neurosurgery, including post-graduate direct patient care experience.

What is the company culture like at CVS Health/Aetna?

CVS Health focuses on building a world of health around consumers with dedicated, purpose-driven colleagues passionate about transforming health care in a more connected, convenient, and compassionate way.

What makes a strong candidate for the Medical Director - Spine role?

A strong candidate will have the required MD/DO with board certification in Orthopedic Spine or Neurosurgery and post-graduate patient care experience, plus previous healthcare insurance experience is preferred.

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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