Oncology Medical Director

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.

Aetna is starting a new Oncology Care Model providing specialized care pathways to our members throughout their oncology treatment.

We are seeking a board-certified Oncologist to be the Oncology Medical Director and lead this new team.

The Oncology Medical Director will run the overall clinical governance, review adverse determinations, provide Physician to Physician reviews, and consult with the team on complex medical necessity decisioning.

The Oncology Medical Director will support a variety of team members in the Oncology Care Model including a Nurse Practitioner, Nurse, Pharmacist, Behavioral Health Specialist and Oncology Companion.

Travel for team meetings and client-facing meetings could happen 1-2 times/quarter

Job functions may include the following:

• Develops the strategy and vision of oncology programs to ensure the consistent delivery of high-quality care.
• Provides clinical oversight and guidance throughout the planning, coordination, and provision of oncology services.
• Reviews and approves treatment plans, evaluates clinical outcomes, and monitors the performance of oncology providers.
• Develops and implements policies and procedures that align with organizational objectives and focus on enhancing oncology services.
• Remains abreast of industry standards, regulatory requirements, and best practices to ensure constant clinical compliance while delivering patient-centric care.
• Collaborates with executives and interdisciplinary leaders to design and implement innovative approaches to meet the needs of patients with oncology conditions.
• Leads cross-functional meetings, committees, and initiatives to coordinate care and promote integration between oncology and other healthcare services.
• Develops relationships with other healthcare organizations, community agencies, and stakeholders to enhance the coordination of care for individuals with oncology needs.
• 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.
• 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.

• Medical Doctor in good standing with no restrictions required. Unrestricted license to practice medicine in the state in which the candidate is located.
• Up to date in Continuing Medical Education (CME) requirements for board certification(s) and licensure (must remain skilled in medical and management areas during employment).
• ABIM Certification in Medical Oncology or AOBIM Oncology Subspecialty Certification
• At least five years post fellowship Oncology experience
• Overnight travel up to 20%

• 10 plus years of post fellowship Oncology experience
• Prior utilization management experience
• Adept at problem solving and decision-making skills
• Mastery multi-tasking abilities with the ability to handle competing deadlines; flexible and adaptable.
• Ability to deal tactfully with customers and community.
• Mastery communication skills used to lead a team.
• Mastery execution and delivery (planning, delivering, and supporting) skills
• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate one.
• Ability to function in clinical settings with diverse cultural dynamics of clinical staff and patients.
• Mastery knowledge of phases of care transitions and resources available for patients.
• Mastery knowledge of digital literacy skills.
• Ability to handle sensitive information ethically and responsibly.

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

The typical pay range for this role is: