CVS Health (501+ Employees, 13% 2 Yr Employee Growth Rate)

5% 1-Year Employee Growth Rate | 13% 2-Year Employee Growth Rate | LinkedIn | $0 Venture Funding

What Is Employee Growth Rate & Why Is It Important?

Job Description
Aetna, a CVS Health Company has an outstanding opportunity for a Senior Medical Director.

Candidate should reside in Maryland, Virginia or the District of Columbia (DC) or be able to travel to this region for meetings “as needed”.

The Senior Medical Director for the Capitol Region provides leadership of medical management activities.

This person will lead a team of Medical Directors and implement medical management programs/policies.

The Capitol Region consists of Maryland, Virginia and the District of Columbia (DC).

Responsibilities:

Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes.

Direct the utilization review process and oversee the quality of utilization determinations.

Ensure compliance with clinical goals through monitoring care management performance.

Responsible for overall medical policies of the unit to ensure the appropriate and most cost effective medical care is received, and for the day-to-day management of medical management staff.

Responsible for recommending changes and enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols.

Develops, implements, and interprets medical policy including medical necessity criteria, clinical practice guidelines, and new technology assessments.

Leads clinical staff in the coordination of quality care 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.

Responsibility for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

Expands Aetna’s medical management programs to address member needs across the continuum of care.

Required Qualifications
Five (5) or more years of experience in clinical practice

Five (5) or more years administrative experience in the health care industry or managed care.

M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
Medical Risk Analysis background.

Education
M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Tagged as: 501+ Employees, Hide US-Only Jobs, Venture Funded

Job Overview
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