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 – Ortho/Total Joint
Location
Connecticut
Posted
1 day ago
Salary
$174.1K - $374.9K / year
Seniority
Lead
Job Description
Medical Director – Ortho/Total Joint
CVS Health
• Support Medical Management staff ensuring timely and consistent responses to members and providers. • Lead all aspects of utilization review/quality assurance, directing case management. • Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. • 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. • Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
Job Requirements
- 2 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 Orthopedic specialty including post-graduate direct patient care experience specifically
- Previous healthcare insurance experience.
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
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