Medical Director (West)
Idaho State Job Bank - Boise, ID
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Medical Director (West) at CVS Health in Boise, Idaho, United States Job Description 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. Position Summary : Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a remote based (work from home) role preferably resides in Pacific NW/MTN states and have a Oregon, Wyoming or Nevada License ( Washington, Utah, Idaho, Montana will also work) without encumbrances. In the Medical Director role you will provide oversight for medical policy implementation. You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care. You will support the Medical Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. The Medical Director will provide clinical, expertise as well as directing case management when necessary. In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. The Medical Director will 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. Required Qual To view full details and how to apply, please login or create a Job Seeker account
Created: 2024-09-07