Medical Director (Medicaid)

A Brief Overview
Administers medical policy. Controls all systems for the development, implementation, and evaluation of clinical and medical programs. Develops strategy to expand the organization's medical management programs to address member needs across the continuum of care.

What you will do

• Establishes policies and programs for case management.
• Implements goals and objectives for quality assurance.
• Advises on organizational standards for medical management programs.
• Develops relationships with leaders of network providers and facilities to support the execution of medical services programs.
• Directs processes for predetermination reviews ad reviews of claim determinations.
• Formulates clinical, coding, and reimbursement policies.
• Ensures strategy for timely and consistent responses to members and providers.
• Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

For this role you will need Minimum Requirements

• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at business intelligence
• Adept at collaboration and teamwork
• Mastery of problem solving and decision making skills
• Mastery of growth mindset (agility and developing yourself and others) skills

Education

• PhD required.

Salary Range The typical salary range for this role is: Min Salary – $169,000.00 Max Salary– $364,000.00 Please keep in mind that this range represents the salary range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location. Business Overview Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Salary : $169,000 - $364,000