Medical Director of Medicare/Consumer Focused Initiatives/Utiliz

Act as primary physician responsible for clinical support of SilverScripts and other Medicare related initiatives including timely, accurate internal review of clinical content of Caremark consumer focused clinical products and services and clinical programs/interventions to meet Medicare, client and corporate requirements for accuracy and consistency of message.

Areas of accountability include physician oversight of utilization management activities, including medical necessity client appeals and backup for medical necessity denials, where required by commercial contracts, governmental (Medicare) regulations or accreditation standards.

Oversees quality of external review organizations (appeals, pharma services) as required by Medicare, client contracts, accreditation and/or regulatory standards, or Caremark SOPs.

Act as primary physician for Caremark consumer focused initiatives, including CHI.
REQUIREMENTS
Knowledge of PBM environment, managed care, utilization management, quality and accreditation standards. Unrestricted active medical license. Excellent verbal, written, interpersonal and presentation skills. Strong Internet research and information retrieval skills. Strong experience in drug information and clinical study design interpretation. Working knowledge of Microsoft applications. (e.g., Word, Excel, PowerPoint)