About the position
CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs). This is a remote based, work from home opportunity. The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services and pipeline activities, and provision of clinical leadership to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned. Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise's decisions and planning.
Responsibilities
- Provide oversight of a portion of CVS Health's clinical programs and commercial client program support.
- Complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate.
- Participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions.
- Perform special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs.
Requirements
- Family Medicine or Internal Medicine Board Certification.
- Minimum of 5 years clinical experience in direct patient care.
- 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs.
- Unrestricted license to practice medicine in the state in which the candidate is located.
Nice-to-haves
- Combination of five years of management and/or clinical experience in a managed care environment and health administration.
- ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine).
- Master's Degree in Public Health Administration or MBA preferred, UM/QA certification desired.
- Proficiency in MS Office Suite.
Benefits
- Affordable medical plan options.
- 401(k) plan (including matching company contributions).
- 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.
