Medical Director - FEHBP

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) role and can be based anywhere in the US.  

Priority will be given to those residing in Arizona and in the Mountain Time Zone.  In this Medical Director role you will provide oversight for medical policy implementation as part of a team dedicated to the Federal Employee Health Benefits Program (FEHBP). You'll 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. In addition, you will oversee utilization review, quality assurance, case management, disease management, benefit planning, and fraud investigation. In this role you'll provide clinical expertise and business direction in support of medical and pharmacy management programs through participation in clinical team activities, presentations, and committees.

You will act as a lead business and clinical liaison to network providers and facilities, plan sponsors, and related vendors, and will support the effective execution of medical services programs by the clinical teams. You will also be responsible for precertification reviews, appeals, and reviews of claim determinations, providing clinical expertise and judgement. Coding and reimbursement expertise is also appreciated but not required.
As a physician leader, you will also maintain your clinical expertise through continuing education and other activities.
** Required Qualifications
** 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Active and current state medical license without encumbrances   M.D. or D.O.
Current Board Certification in a recognized specialty including post-graduate direct patient care experience.
** Preferred Qualifications
** Health plan/payor experience.
Electronic medical systems/record experience   Managed Care experience   Family Medicine or Internal Medicine Background   Residing in Arizona or in the Mountain Time Zone
** Education
* * M.D. or D.O.
** 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 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…