Oncology Medical Director

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

📋 Description

• Oversee Aetna’s new Oncology Care Model by delivering specialized treatment pathways throughout members’ oncology journey.

• Manage overall clinical governance.

• Evaluate adverse determinations and facilitate Physician to Physician reviews.

• Collaborate with the team on intricate medical necessity decision-making.

• Support the Oncology Care Model team, which includes a Nurse Practitioner, Nurse, Pharmacist, Behavioral Health Specialist, and Oncology Companion.

• Create the strategy and vision for oncology programs.

• Provide clinical oversight and guidance in the planning, coordination, and delivery of oncology services.

• Assess and approve treatment plans, evaluate clinical outcomes, and monitor the performance of oncology providers.

• Develop and implement policies and procedures aimed at enhancing oncology services.

• Ensure clinical compliance with industry standards, regulatory requirements, and best practices.

• Partner with executives and interdisciplinary leaders to explore innovative approaches for oncology patients.

• Lead cross-functional meetings, committees, and initiatives to streamline care and integrate oncology services.

• Build relationships with healthcare organizations, community agencies, and stakeholders.

• Administer medical policy.

• Oversee systems for the development, implementation, and evaluation of clinical and medical programs.

• Expand medical management programs to meet member needs across the continuum of care.

• Set and achieve quality assurance goals and objectives.

• Provide guidance on organizational standards for medical management programs.

• Foster relationships with network providers and facility leaders.

• Direct processes for predetermination and claim determination reviews.

• Formulate policies regarding clinical, coding, and reimbursement issues.

• Ensure prompt and consistent communication with members and providers.

• Manage team performance through regular feedback and official performance evaluations.

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

⛳️ Requirements

• Medical Doctor in good standing with no restrictions is required.

• Unrestricted medical practice license in the state where the candidate resides.

• Current in Continuing Medical Education (CME) requirements for board certification(s) and licensure.

• ABIM Certification in Medical Oncology or AOBIM Oncology Subspecialty Certification.

• Minimum of five years of post-fellowship experience in Oncology.

• Willingness to travel overnight up to 20% of the time.

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine.

• Preferred: Over 10 years of post-fellowship Oncology experience.

• Preferred: Previous experience in utilization management.

• Preferred: Skills in problem-solving and decision-making.

• Preferred: Ability to multitask and manage competing deadlines.

• Preferred: Communication skills effective for team leadership.

• Preferred: Skills in planning, delivering, and supporting initiatives.

• Preferred: Ability to evaluate relative costs and benefits of potential actions.

• Preferred: Capacity to operate in clinical settings with diverse cultural dynamics.

• Preferred: Understanding of phases of care transitions and available patient resources.

• Preferred: Proficiency in digital literacy.

• Preferred: Capability to handle sensitive information with ethics and responsibility.

🏝️ Benefits

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

• 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.