Medical Director – Radiation Oncology

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in oncology initiatives across the organization

• Manage utilization review and quality assurance processes

• Conduct predetermination reviews and assess claim determinations

• Contribute to the implementation of medical policies

• Execute prior authorization, pre-certification, concurrent reviews, peer-to-peer discussions, and first-level appeals

• Engage in special projects and committees as required

• Offer expertise in clinical practices, coding, and reimbursement

• Lead case management when necessary

• Design, implement, and assess clinical and medical programs

• Broaden medical management programs to meet member needs throughout the care continuum

• Assist Medical Management personnel in delivering prompt and consistent responses to members and providers

• Provide clinical insights and business guidance through involvement in clinical team activities

• Serve as a clinical and business liaison to network providers and facilities

• Travel for team meetings and client-facing engagements 1–2 times per quarter

• Partake in weekend, holiday, and on-call rotations

⛳️ Requirements

• M.D. or D.O. with a current, active U.S. state medical license in good standing

• Board certified in Radiation Oncology, recognized by the American Board of Medical Specialties or American Osteopathic Association

• Eligible to obtain additional state licensure as necessary

• Over 3 years of pertinent radiation oncology experience in a patient care or managed care environment post-residency

• Willingness to travel 1–2 times per quarter for team or client meetings

• Previous utilization management experience with a Health Plan/Payor is preferred

• Prior experience as a Physician Advisor in a Health/Hospital system is preferred

• Willingness to participate in weekend, holiday, and on-call rotations

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program

• Award target in the company’s equity award program

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources supporting physical, emotional, and financial well-being