Medical Director, CVS Health

CVS Health

Location:
United States, Kansas

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job offer has expired

Job Description:

In the Medical Director role, you will provide oversight for medical policy implementation, support medical management staff, ensure quality assurance in utilization review, and participate in development of clinical programs while acting as a lead liaison to network providers and facilities at CVS Health.

Job Responsibility:

Provide oversight for medical policy implementation
Participate in the development, implementation, and evaluation of clinical / medical programs
Expand Aetna's medical management programs to address member needs
Support the Medical Management staff to ensure timely and consistent responses
Oversee utilization review and quality assurance
Conduct predetermination reviews and reviews of claim determinations
Handle Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects
Participate in committee tasks when necessary
Provide clinical, coding, and reimbursement expertise
Direct case management when needed
Act as lead liaison to network providers and facilities

Requirements:

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

Nice to have:

Previous UM experience with a Health Plan / Payor/ Physician Advisor in a Healthcare system
Board Certification in Internal Medicine, Family Medicine, Emergency Medicine or Med / Peds / General Surgery

What we offer:

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

Additional Information:

Job Posted:
September 30, 2025

Expiration:
September 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director