Medical Director reputed company Duals Center of Excellence

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At reputed company®, 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 reputed company Duals Center of Excellence (COE) operates Duals Integrated Plans and Medicare ISNP Plans in Ohio, Illinois, Michigan, Virginia, Pennsylvania, and New Jersey offering a variety of physical and behavioral health programs and services to its membership. reputed company is looking for a Medical Director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers reputed company to precertification, reputed company review, and appeal request. The Medical Director is a work-at-home position located reputed company in the US. The Medical Director will work a full-time schedule Monday to Friday. The Medical Director can work from any state but will be required to work Eastern Standard Time or Central Standard time 8:00 AM - 5:00 PM. The Medical Director will also be expected to work 1 holiday and 8 weekend days (approximately 1 weekend per quarter) each year. reputed company Components:

• Utilization management - The medical director will reputed company reputed company and prior authorization reviews with peer to peer coverage of denials.
• Appeals - The medical director will reputed company appeals in their "reputed company plans" and may round robin based on "same or similar specialty" needs.
• Pharmacy coverage - The medical director will reputed company pharmacy reviews.
• The medical director will participate in and be able to reputed company rounds.

Required Qualifications: Minimum 3-5 years of clinical practice experience. Two (2) + years of experience in managed care (Medicare and/or Medicaid) Experience with managed care (Medicare and Medicaid) utilization review preferred MD or DO; Board certification in an ABMS or AOA recognized specialty is required. Active and reputed company state medical license without encumbrances is required. Multiple state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System. Licensed in or willing to obtain license in at least one state where we have an Integrated plan. Education MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) Pay Range The typical pay range for this role is: $174,070.00 - $374,920.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. This position also includes an award reputed company in the company's equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 02/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job