Medical Director, CVS Health

CVS Health

Location:
United States, Texas

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

CVS Health is offering an opportunity for a Medical Director. The position involves clinical expertise and business direction supporting medical management programs, with a focus on clinical and payment policy. Responsibilities include supporting the appeals process, clinical claim review, and predeterminations in both commercial and Medicare environments. This is a remote position located in the U.S., offering competitive pay, benefits, and unique opportunities with a Fortune 6 company.

Job Responsibility:

Support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment
Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services
Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services
Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company
Work collaboratively with functional areas

Requirements:

Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry
Active and current state medical license without encumbrances
M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience

Nice to have:

Health plan/payor experience
Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems
Strong communication skills both written and verbal

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
November 22, 2025

Expiration:
December 15, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director