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Medical Director
| Company | CVS Health |
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| Location | Florida, 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, Expert or higher |
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Requirements
- Active and current state medical license in FL state without encumbrances
- M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
Responsibilities
- Provide oversight for medical policy implementation
- Participate in the development, implementation, and evaluation of clinical / medical programs
- Support the Medical Management staff ensuring timely and consistent responses to members and providers
- Focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews
- Conduct Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed
- Provide clinical expertise as well as directing case management when necessary
- Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Preferred Qualifications
- Previous UM experience with a Health Plan / Payor
- Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Med / Peds Specialty Preferred
