Medical Director - Radiation Oncology - MD or DO

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.

This is a remote based (work from home) position

One may live anywhere in the United States

This is a full-time/exempt-level position, and the hours will typically be around the framework of 9:00-6:00 Eastern Time

Travel for team meetings and client-facing meetings could happen 1-2 times/quarter

Support Oncology initiatives throughout the enterprise

As a Medical Director you will focus primarily on overseeing utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations, In the Medical Director role you will provide input for medical policy implementation.

This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.

The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.

You will participate in the development, implementation, and evaluation of clinical / medical programs and expand medical management programs to address member needs across the continuum of care.

You will support the Medical Management staff ensuring timely and consistent responses to members and providers.

In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.

The Medical Director will act as a business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.

Participate in a weekend, holiday and on-call rotation.

Required Qualifications

M.D. or D.O. with a current, active, U.S. state medical license that is in good standing

Board certified in Radiation Oncology, recognized by the American Board of Medical Specialties, or American Osteopathic Association

Eligible to acquire additional state licensure as required

3+ years of relevant radiation oncology experience in a patient care, or managed care setting post residency

Ability to travel 1-2 times/quarter for team, or client-facing meetings

Preferred Qualifications

Previous UM experience with a Health Plan / Payor.

Previous UM experience as a Physician Advisor in a Health / Hospital system.