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CVS Health

CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca

Medical Director – Medical Policy Ops, DRG

Location

Connecticut

Posted

91 days ago

Salary

$174.1K - $374.9K / year

Seniority

Lead

Professional Certificate5 yrs expEnglish

Job Description

Medical Director – Medical Policy Ops, DRG

CVS Health

• providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy • transactional reviews in support of the appeal process • clinical claim review process • predetermination of covered benefits in the Commercial and Medicare environments • participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve quality and efficiency of health care services • apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests • proactively use data analysis to identify opportunities for quality improvement

Job Requirements

  • Five (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

Benefits

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs

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