Medical Director - Medical Affairs (Oncology)

$174,070 - $374,900/Yr

CVS Health - Frankfort, KY

Full-time - Senior

Frankfort, KY

1-10 employees

Health and Personal Care Retailers

About the position

CVS Health, a Fortune 4 company, is seeking a Medical Director - Medical Affairs with a focus on Oncology. This role is pivotal in providing clinical business support across the enterprise, ensuring clinical oversight and mentorship for CVS Health's clinical programs. The Medical Affairs department is responsible for a variety of functions including PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services, and pipeline activities. The Medical Director will also provide clinical leadership to various internal departments such as specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, and Accreditation. In this position, the Medical Director will report directly to the Medical Affairs Department and will be responsible for clinical support and consultative activities across the PBM. This includes providing consultative clinical support to Account Management for assigned Key Clients. The Medical Director will engage in Utilization Management (UM) activities, which encompass prior authorization and appeals, and will respond to prescriber inquiries related to UM transactions and CVS Health coverage policies. Medical Directors at CVS Health are expected to exemplify the highest levels of clinical integrity, knowledge, and cross-functional decision-making. They represent the clinical decision-making and professional thought process of prescribers, acting as partners in the enterprise's decision-making and planning processes. Each Director will oversee a portion of CVS Health's clinical programs and commercial client program support, sharing in the reviews of utilization management criteria and clinical policy revisions. The role involves completing assigned medication utilization reviews and medical necessity appeals for various clients, including commercial and governmental programs. Medical Directors will also participate in inter-rater review activities and quality oversight processes for internal UM decisions. They may be required to support other segments on evening and weekend coverage, depending on their assignment. Additionally, the Medical Director will conduct special clinical investigations and research as requested by the Senior Medical Director, which may involve literature reviews or collaborative projects with pharmacists and other business units.

Responsibilities

• Provide clinical support and consultative activities across the PBM.
• Engage in Utilization Management (UM) activities including prior authorization and appeals.
• Respond to prescriber inquiries related to UM transactions and CVS Health coverage policies.
• Model the highest levels of clinical integrity and cross-functional decision-making.
• Oversee a portion of CVS Health's clinical programs and commercial client program support.
• Complete assigned medication utilization reviews and medical necessity appeals for various clients.
• Participate in inter-rater review activities and quality oversight processes for internal UM decisions.
• Conduct special clinical investigations and research as requested by the Senior Medical Director.

Requirements

• Minimum of 5 years clinical experience in direct patient care.
• 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs.
• Unrestricted license to practice medicine in the state in which the candidate is located.
• Graduate of an accredited Medical School and Residency Program.
• ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine).
• Required annual Continuing Medical Education (CME) up to date.

Nice-to-haves

• Combination of five years of management and/or clinical experience in a managed care environment and health administration.
• Master's Degree in Public Health Administration or MBA preferred.
• UM/QA certification desired.
• Internal Medicine or Family Medicine Board Certification highly desired.
• Proficiency in MS Office Suite.

Benefits

• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan available for eligible employees.
• Fully-paid term life insurance plan for eligible employees.
• Short-term and long-term disability benefits.
• Numerous well-being programs.
• Education assistance and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.