Medical Director Jobs

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. Position Summary - Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests. - Promotes and supports quality effectiveness of healthcare and Pharmacy Services. - Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines. - Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria. - Determines appropriateness for medications. Communicates decision to physicians, physician’s office staff, medical management staff, members, and/or pharmacists. - Will perform clinical research to support request. - Performs non-medical research including eligibility verification, COB, and benefits verification. - Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. - Process requests in compliance with various laws and CMS regulations and company policies and procedures. - May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers. - Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services. - Sedentary work involving significant periods of sitting, tal

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. Position Summary This is a remote work from home role anywhere in the US but must be able to work EST hours. Working hours will be Monday-Friday 8am-4:30pm EST. No weekends, holidays, or travel will be required. The Clinical Case manager is a licensed Clinical Social Worker position. This role partners with a registered nurse case manager to utilize a collaborative process of assessment, planning, and advocacy to meet a member’s benefit plan and/or health needs. Responsibilities include researching available options and resources for members with financial, transportation, safety and housing needs. Population spans the entire lifecycle. All member contact is done telephonically or via electronic exchange. This position works to empower members to make positive lifestyle and medical choices and works as a team with other clinical staff to assist members with community resources for medical, financial and behavioral health. Required Qualifications Must live in North Carolina Master's Degree in Social Work

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Full Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Full Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Part Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Part Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Full Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Part Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Part Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Full Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Part Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Part Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work with Signify Health as a clinician colleague, fulfilling

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. Position Summary - Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication

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. Registered Nurse must hold a CDCES- Certified Diabetes Care and Education Specialist This is a full-time telework role for a RN who resides in a compact state and holds a compact license. Working schedule: Monday-Friday, standard business hours, including 1 evening shift per week from 12:30- pm EST -The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status for chronic conditions. - Assessment of members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. -Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. -Enhancement of Medical Appropriateness & Quality of Care: -Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. -Usi

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. Do you have a passion for engaging with people and helping them on their journey to better health? Signify Health, part of CVS Health®, is seeking a Part Time Clinician (Nurse Practitioner or Physician Assistant) to provide In-Home Health Evaluations, engaging with people in the comfort of their own homes and helping bridge gaps in care. You’ll play a critical role in building trusted relationships to make people healthier, helping bring flexible, comprehensive and personalized health evaluations right to people’s front doors. Job highlights The visit, which lasts about 45 minutes, allows for time to connect one-on-one and answer health questions. It includes a medication and medical history review, a physical evaluation, and, if ordered by the person’s health plan, additional diagnostic tests (i.e., diabetic eye exams, spirometry, etc.). You’ll use an iPad and an intuitive clinical workflow for each evaluation and are not required to prescribe medicine, order lab tests or alter people’s current treatment regimen. In this role, you will: Bring your heart into every visit, joining a national network of purpose-driven clinicians dedicated to improving health outcomes Be part of our efforts to visit millions of people nationwide with the goal of providing connections to the right care for people’s unique needs Work