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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.
Job Responsibility:
Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests
Primarily responsible for Utilization Management, including prior authorization and precertification as well as concurrent review
Cases could focus on inpatient or outpatient, acute and post-acute as well as peer to peer calls and first level appeals
Participate in a rotating on call schedule to provide weekend and holiday coverage
Requirements:
Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry
Active and current West Virginia state medical license without encumbrances as well as the ability to obtain Florida, Louisiana and Kentucky licenses
M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty
including post-graduate direct patient care experience
Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred
Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus +
Nice to have:
Health plan/payor Utilization Management / Review experience
Electronic medical systems/record experience
Managed Care experience
Medicaid experience
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching