Medical Director

hace 7 días

Rosario, Santa Fe, Argentina CVS Health A tiempo completo
CVS Health Medical Director - Commercial Appeals in Santa Fe, New Mexico

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.

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.

Preferred candidates will have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification.

In the Medical Director role, you will provide oversight for medical policy implementation. 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 review appeal cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited Appeals / Appeal Hearings / 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. The Medical Director will act as a business and clinical liaison to network providers and facilities if needed, to support the effective execution of medical services programs by the clinical teams.

Required Qualifications

  1. Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
  2. Active and current state medical license without encumbrances.
  3. M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.

Preferred Qualifications

  1. Active and current state medical license in CA without encumbrances and willing to obtain an AZ medical license if needed.
  2. Internal Medicine background.

Education

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

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.

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: 04/30/2025.

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.

#J-18808-Ljbffr

  • Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Genesis Healthcare A tiempo completo

    Genesis Healthcare Medical Director in Santa Fe, New MexicoWe are offering a five thousand dollar sign-on bonusSub-Acute, Long-Term Care is a sector of healthcare exploding with potential and work-life balance flexibility (no weekends or on call)We are seeking a part-time (16-24 hours per week) Attending Physician/Medical Director for our Casa Real Center...

  • Executive Medical Director

    hace 7 días

    Rosario, Santa Fe, Argentina CVS Health A tiempo completo

    We're seeking a results-driven Medical Director to join our team at CVS Health. As a Medical Director, you will be responsible for overseeing the development and implementation of medical policies, as well as resolving appeals for denied medical services.You'll work closely with our Medical Management team to ensure that our clinical strategies align with...

  • Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    Become a part of our caring community and help us put health firstThe Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The Medical...

  • Medical Director

    hace 5 días

    Rosario, Santa Fe, Argentina CVS Health A tiempo completo

    CVS Health Medical Director - Commercial Appeals in Santa Fe, New Mexico 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,...

  • Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    Humana Medical Director - Medicaid N. Central in Santa Fe, New MexicoBecome a part of our caring community and help us put health firstThe Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth...

  • Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    Humana Medical Director - Care Plus - Florida in Santa Fe, New MexicoBecome a part of our caring community and help us put health firstThe Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth...

  • Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    Humana Medical Director - Florida in Santa Fe, New MexicoBecome a part of our caring community and help us put health firstThe Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of...

  • Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    Humana Medical Director - Mid West Region in Santa Fe, New MexicoBecome a part of our caring community and help us put health firstThe Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work...

  • Medical Director Specialist

    hace 3 días

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    About the RoleWe are seeking a highly skilled Medical Director to join our team at Humana. As a Medical Director, you will be responsible for overseeing the medical aspects of our healthcare services, ensuring that they meet the highest standards of quality and care.Key ResponsibilitiesProvide medical interpretation and determinations on services provided by...

  • Physician Medical Director Position

    hace 3 días

    Rosario, Santa Fe, Argentina Evolent A tiempo completo

    Career OpportunityEvolent offers a unique career opportunity for a skilled Physician Medical Director to join our utilization management team. As a Radiology Field Medical Director, you will have the chance to apply your clinical expertise in a non-clinical setting, working collaboratively with a dynamic team. This role requires strong clinical, management,...

  • Physician Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    Location field must contain 'city, state' or a zip code to perform a radius search (e.g., Denver, CO or 46122 ). City and state must be separated by a comma followed by a space (e.g., Houston, TX).Become a part of our caring community and help us put health firstThe Long-term services and supports (LTSS) Medical Director's primary responsibility is the...

  • Field Medical Director, Cardiology

    hace 3 días

    Rosario, Santa Fe, Argentina Evolent A tiempo completo

    Location field must contain 'city, state' or a zip code to perform a radius search (e.g., Denver, CO or 46122 ).City and state must be separated by a comma followed by a space (e.g., Houston, TX )Evolent Field Medical Director, Cardiology in Santa Fe, New MexicoYour Future Evolves Here Evolent partners with health plans and providers to achieve better...

  • Field Medical Director, Cardiology

    hace 1 semana

    Rosario, Santa Fe, Argentina Evolent A tiempo completo

    Location field must contain 'city, state' or a zip code to perform a radius search (e.g., Denver, CO or 46122 ). City and state must be separated by a comma followed by a space (e.g., Houston, TX )Evolent Field Medical Director, Cardiology in Santa Fe, New MexicoYour Future Evolves HereEvolent partners with health plans and providers to achieve better...

  • Medical Director

    hace 5 días

    Rosario, Santa Fe, Argentina Highmark Health A tiempo completo

    Highmark Health Medical Director in Santa Fe, New Mexico Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical...

  • Medical Director

    hace 1 semana

    Rosario, Santa Fe, Argentina Highmark Health A tiempo completo

    Highmark Health Medical Director in Santa Fe, New MexicoCompany : Highmark Inc.Job Description :JOB SUMMARYThis job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy...

  • Medical Director-Claims Management

    hace 1 semana

    Rosario, Santa Fe, Argentina Humana A tiempo completo

    Humana Medical Director--Claims Management in Santa Fe, New MexicoBecome a part of our caring community and help us put health firstThe Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the...

  • US Scientific Director, Medical Affairs

    hace 1 semana

    Rosario, Santa Fe, Argentina Merck A tiempo completo

    Merck US Scientific Director, Medical Affairs - Cardiovascular & Metabolism (Remote) in Santa Fe, New MexicoJob DescriptionRole SummaryThe US Scientific Director, Medical Affairs (SDMA) is a regionally based position in our Company's Research Laboratories, US Medical Affairs (our Research & Development Division, USMA). The role drives scientific excellence...

  • Medical Director of Utilization Management

    hace 3 días

    Rosario, Santa Fe, Argentina Evolent A tiempo completo

    About EvolentEvolent partners with health plans and providers to deliver better healthcare outcomes for people with complex and costly health conditions. We bridge the gaps in the fragmented healthcare system, ensuring that patients receive the same level of care and compassion that we would want for our loved ones.We prioritize work-life balance,...

  • Field Medical Director, Radiology

    hace 3 días

    Rosario, Santa Fe, Argentina Evolent A tiempo completo

    Evolent Field Medical Director, Radiology (ENT Preferred) in Santa Fe, New MexicoYour Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions.Working across specialties and primary care, we seek to connect the pieces of a fragmented health care system and...

  • Medical Director

    hace 3 días

    Rosario, Santa Fe, Argentina Evolent A tiempo completo

    Company Overview">Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. We work across specialties and primary care to connect the pieces of a fragmented healthcare system, ensuring that individuals receive consistent care and compassion.We believe that people do their best...