Medical Director

CVS Health • Phoenix, AZ • 15h ago

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

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. Ideal Candidates will reside in Arizona and have a medical license without encumbrances.

In this role you will:

Support Mercy Care

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 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 and quality assurance while being responsible for predetermination reviews and review of claim determinations.

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, coding, and reimbursement 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.

Participate in a weekend, holiday and on-call rotation.

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.

*Overnight travel up to 10%

*AZ medical license without encumbrances

Preferred Qualifications:

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

Education:

Medical Doctor or Doctor of Osteopathic Medicine

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,920.00

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/16/2025

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

We are an equal opportunity and affirmative action employer. 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.

Similar Jobs

Charge Nurse

Dignity Health • Phoenix, AZ • 15h ago

Hospital & Medical

Responsibilities Leadership and Supervision: Overseeing Nursing Staff: The Charge Nurse supervises and coordinates the activities of other nurses and healthcare staff Staff Scheduling and Assignment: The Charge Nurse ass...

15h ago

Go to Apply

Registered Nurse

BioLife Plasma Services • Glendale, AZ • 15h ago

Hospital & Medical

By clicking the "Apply" button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda's Privacy Notice an...

15h ago

Go to Apply

BAYADA Home Health Care • Mesa, AZ • 1d ago

Hospital & Medical

Make an Impact as a Registered Nurse at BAYADA Home Health Care BAYADA Home Health Care is currently seeking a Registered Nurse (RN) to join our Glendale Visits team. You will be an integral member of a multi-disciplinar...

1d ago

Go to Apply

Medical Account Manager

Mitsubishi Chemical Group • Phoenix, AZ • 2d ago

Hospital & Medical

Medical Account Manager (2063) Title:Medical Account Manager Group Company: Mitsubishi Chemical Advanced Materials Location:Remote Employment Type:Full time Group Company: Mitsubishi Chemical Advanced Materials Mitsubish...

2d ago

Go to Apply

Nurse Neonatal ICU

Dignity Health • Phoenix, AZ • 2d ago

Hospital & Medical

Responsibilities Caring for the smallest and most fragile lives yields some of the greatest personal and professional rewards. This is what you'll experience when you join the family-centered Nursery Intensive Care Unit...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.