Medical Director - Georgia Gulf States

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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) position for the Georgia and Gulf States Region (LA, MS, AL, and AR). The preferred candidate will reside in one of these states. Even if the candidate does not reside in one of these states, the candidate should have the ability to learn about this market – hospitals, outpatient networks, and value-based care relationships.

The Medical Director will be responsible for overseeing the utilization review for health systems in this region. An ideal candidate would have experience performing in-hospital utilization reviews and other quality activities. The Medical Director will be required to have a state medical license without encumbrances or the ability to obtain the license within a reasonable timeframe.

Collaboration and teamwork are the defining characteristics of our Medical Director team; in order to be a successful member of the team the candidate must exemplify these qualities.

• As a Medical Director you will focus primarily on overseeing utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals.
• 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. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.

Required Qualifications:

*Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.

*Active and current medical license without encumbrances.

*M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.

*Experience with technology such as Microsoft Outlook and Teams.

Preferred Qualifications:

Residence in one of the states in the Georgia and Gulf States Region (LA, MS, AL, and AR)

Previous UM experience with a Health Plan / Payor.

Previous UM experience as a Physician Advisor in a Health / Hospital system.

Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine Preferred.

Education:

Medical Doctor or Doctor of Osteopathic Medicine

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.