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Medical Director - Physician Services - Neurologist

Company: CVS Pharmacy
Location: Scottsdale
Posted on: September 12, 2020

Job Description:

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Job ID:

1337802BR

Location:

AZ - Scottsdale

Street Address:

9501 E Shea Blvd

Category:

Medical Director

Job Description

Are you passionate about improving the health outcomes of CVS Health patients? A Medical Director role in Medical Affairs may be what you are seeking!

This work at home opportunity provides flexibility and can be located anywhere in the country. The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Caremark clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services and pipeline activities, and provision of clinical leadership to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation).

This position will report to the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. The Medical director may provide consultative clinical support to Account Management in support of Key Clients as assigned.

This position transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Caremark coverage policies.

Medical Directors at CVS Caremark are encouraged to model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise’s decisions and planning.

- Each Director is responsible for providing oversight of a portion of CVS Caremark‘s clinical programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews.

- Proven experience working in pharmacy benefit management (PBM) or managed care organization owning the development and maintenance of clinical content across several programs with experience in Oncology.

- Directors will spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (i.e., Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage.

- Supervise the patient’s progress and assessment results to communicate clinical and technical information with the physician and other members of healthcare team. Most patient contact will be on the phone and, on occasion, you will meet them in our infusion suites.

- Will perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of published literature around specific pharmaceutical questions or more in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Department.

Required Qualifications

Graduate of an accredited Medical School and Residency Program

ABMS OR AOA BOARD CERTIFIED IN NEUROLOGY

Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia

Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.

Minimum of 5 years clinical experience in direct patient care.

Proven experience in clinical outcomes, solid understanding of medical statistics, regulatory agencies, and analytic programs

Preferred Qualifications

Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired

Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as a teammate (e.g., RNs, PharmDs, etc.).

Education

M.D. or D.O. degree required

Business Overview

At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

We are committed to a workplace that supports diversity, inclusion and belonging. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT.

Please note that we only accept applications for employment via this site. We provide reasonable accommodations to individuals with disabilities. To request an accommodation, including a qualified interpreter, written information in other formats, translation or other services, please email AdviceandCounsel@cvshealth.com or call 877-805-9511.If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com . For technical issues with the Virtual Job Tryout, contact the Modern Hire Help Desk at 1-877-451-1695 or cvs_support@modernhire.com .The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. We encourage you to visit our COVID-19 resource center at  https://cvshealth.com/covid-19  to learn more. Please be aware that CVS Health does not will never solicit money or offer payment for job applications, nor do we ask candidates to email or submit any personal information over unsecured channels. To learn more, please visit  https://jobs.cvshealth.com/FAQ .

Changing the future of health care at CVS Health

It's a New Day in Health Care at CVS Health

About CVS Health At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.

Keywords: CVS Pharmacy, Scottsdale , Medical Director - Physician Services - Neurologist, Other , Scottsdale, Arizona

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