Are you passionate about improving the health outcomes of CVS Health patients? A Medical Director role in Medical Affairs may be what you are seeking!
This work at home opportunity provides flexibility and can be located anywhere in the country.
The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Caremark 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).
This position will report to the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. The Medical director may provide consultative clinical support to Account Management in support of Key Clients as assigned.
This position transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Caremark coverage policies.
Medical Directors at CVS Caremark 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.
– Each Director is responsible for providing oversight of a portion of CVS Caremark‘s clinical programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews.
– Directors will spend a portion of most days completing 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.
– Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (i.e., Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage.
– Will perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of published literature around specific pharmaceutical questions or more in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Department.
Graduate of an accredited Medical School and Residency Program
ABMS OR AOA BOARD CERTIFIED IN INTERNAL MEDICINE OR FAMILY MEDICINE
Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia
Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
Minimum of 5 years clinical experience in direct patient care.
Proven experience in clinical outcomes, solid understanding of medical statistics, regulatory agencies, and analytic programs
Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired
Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as a teammate (e.g., RNs, PharmDs, etc.).
M.D. or D.O. degree required
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.