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Medical Director – Pain Management
Location
Connecticut
Posted
2 days ago
Salary
$174.1K - $374.9K / year
Seniority
Lead
Job Description
Medical Director – Pain Management
CVS Health
• Provide clinical leadership and expertise to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers. • Lead utilization management and quality assurance activities, including oversight of medical necessity reviews and case management initiatives. • Support medical management programs through active participation in interdisciplinary clinical team activities and strategic decision-making. • Serve as the primary clinical and business liaison to network providers and healthcare facilities, fostering collaboration and supporting the effective implementation of medical services programs. • Conduct predetermination reviews and claim determination reviews, applying clinical judgment and expertise in medical coding, reimbursement, and coverage policies. • Provide guidance and consultation on complex clinical cases, helping ensure quality outcomes and regulatory compliance. • Support the development and continuous improvement of medical management strategies, policies, and processes.
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 Pain Management specialty including post-graduate direct patient care experience specifically
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- comprehensive benefits package
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