FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Medical Director – Aetna Duals Center of Excellence
CVS Health. Perform concurrent and prior authorization reviews with peer-to-peer coverage of denials .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management and clinical practice, with a strong focus on concurrent and prior authorization reviews, appeals, and pharmacy reviews. Holds an MD or DO with board certification and an active state medical license, ensuring compliance with managed care standards.
Highest-signal resume keywords
Utilization ManagementClinical Practice ExperienceMD Or DOBoard CertificationActive State Medical License
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Concurrent ReviewPrior AuthorizationAppeals ManagementPharmacy ReviewsClaims Determination
Soft Skills
Timely CommunicationLeadership
Certifications & Qualifications
Board Certification In ABMS Or AOA Specialty
Industry Keywords
Managed CareMedicareMedicaidHealth PlanHealth System
About the role
Key responsibilities & impact- Perform concurrent and prior authorization reviews with peer-to-peer coverage of denials
- Perform appeals in assigned “base plans” and round robin based on same or similar specialty needs
- Perform pharmacy reviews
- Participate in and lead rounds
- Support Medical Management staff with timely and consistent responses to members and providers regarding precertification, concurrent review, and appeal requests
- Work a full-time Monday-to-Friday schedule
Requirements
What you’ll need- Minimum 3-5 years of clinical practice experience
- Two (2) + years of experience in managed care (Medicare and/or Medicaid)
- Experience with utilization management (preferred Medicare and/or Medicaid)
- MD or DO
- Board certification in an ABMS or AOA recognized specialty is required
- Active and current state medical license without encumbrances is required
- Florida license or ability to obtain
- Previous experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System preferred
- Licensed in or willing to obtain license in at least one state where we have an Integrated plan
- Ability to work Eastern Standard Time or Central Standard Time from 8:00 AM to 5:00 PM
- Availability to work 1 holiday and 8 weekend days each year
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program
- Equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being