Medical Director - Radiation Oncology - MD or DO
Core
Medical Director supporting CVS Health Specialty oncology business in managing oncology utilization, clinical reviews, and growing the oncology footprint.
Role type
Senior IC Medical Director (Radiation Oncology)
Builds
Medical management programs and clinical/policy implementation for oncology services
Domain
Health Insurance / Managed Care / Radiation Oncology
Deliverable
dashboards & analysis
Required skills
Radiation Oncology clinical expertise, Utilization Review, Prior Authorization, Peer-to-Peer calls, Medical Policy implementation, Clinical coding, Reimbursement expertise, Case management
Preferred skills
UM experience with Health Plan/Payor, Physician Advisor experience in Health/Hospital system
Technologies
None stated
Responsibilities
Oversee utilization review and quality assurance, conduct predetermination reviews and claim determinations, provide input for medical policy implementation, support Medical Management staff with timely responses to members and providers, act as business and clinical liaison to network providers, participate in weekend/holiday/on-call rotation
Seniority
Senior, hands-on IC
