Medical Director, CVS Health

CVS Health

Location:
United States, Work At Home, Kansas

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Provide oversight for medical policy implementation
Participate in the development, implementation, and evaluation of clinical / medical programs
Support the Medical Management staff ensuring timely and consistent responses to members and providers
Focus primarily on overseeing utilization review and quality assurance
Responsible for predetermination reviews and review of claim determinations
Provide clinical, coding, and reimbursement expertise
Direct case management when necessary
Provide clinical expertise and business direction in support of medical management programs
Act as lead business and clinical 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 Preferred

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues 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:
August 02, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director