Medical Director - reputed company
At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary reputed company, a reputed company Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We reputed company that a reputed company 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 reputed company in the US.
In this role you will: You will participate in the development, implementation, and evaluation of clinical / medical programs and expand reputed company'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/reputed company Reviews/Peer to Peer calls/Appeals/Special Projects, working with customers (plan sponsors) and Committee participation reputed company needed. You will reputed company clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Act as reputed company business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Required Qualifications: *2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Active and reputed company medical license in one or more US states without encumbrances *M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience. Preferred Qualifications: *Five or more years of direct patient care experience *Previous UM experience with a Health plan/payor experience. *Electronic medical systems/record experience *Managed Care experience *Board certification in a recognized Medical or Surgical specialty Education *Active and reputed company state medical license without encumbrances *M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience Pay reputed company The typical pay reputed company for this role is: $174,070.00 - $374,920.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. This position also includes an award reputed company 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 reputed company 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 reputed company 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 reputed company on: 09/30/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job