Job Title

Job DescriptionReady to take your Medical Director skills to the next level with a Fortune 5 company? Check out this opportunity with Aetna, a CVS Health companyThe Medical Director is a "Work from Home" position supporting the New York Market with expected work hours being Eastern Standard Time Zone (EST) Active and Unencumbered New York State Medical License Required. In the Medical Director role you will provide oversight for medical policy implementation. Your primary responsibility will be Utilization management consisting of predetermination reviews as well as reviews of claim determinations, and providing clinical, coding, and reimbursement expertise.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 addition you will oversee utilization review / quality assurance, directing case this role you'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities and act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.Required QualificationsFive (5) 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., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience; Internal Medicine PreferredCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsHealthcare Insurance ExperienceManaged Care Experience with Medicare Reviews and Value Based Contracts (VBC's)Utilization Review ExperienceEducationActive and current New York State medical license without encumbrancesM.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.