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Medical Director
| Company | CVS Health |
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| Location | Kentucky, USA |
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| Salary | $174070 – $374920 |
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| Type | Full-Time |
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| Degrees | MD |
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| Experience Level | Senior |
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Requirements
- Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and current Kentucky state medical license without encumbrances as well as the ability to obtain a Florida, Louisiana and West Virginia.
- M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty; including post-graduate direct patient care experience
- Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred.
- Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus +
Responsibilities
- Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.
- Responsible for Utilization Management, including prior authorization and pre certification as well as concurrent review.
- Handle cases focusing on inpatient or outpatient, acute and post acute as well as peer to peer calls and first level appeals.
Preferred Qualifications
- Health plan/payor Utilization Management / Review experience.
- Electronic medical systems/record experience.
- Managed Care experience.
- Medicaid experience.
