Medical Director, CVS Health

Medical Director

CVS Health

Location:
United States, California

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

Medical Director role focusing on clinical expertise and oversight of medical management programs at CVS Health, including utilization review and supporting medical management staff. Responsible for policy implementation, predetermination reviews, and liaising with network providers.

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 across the continuum of care
Support Medical Management staff ensuring timely and consistent responses to members and providers
Oversee utilization review/quality assurance
Be responsible for predetermination reviews, including Prior Authorization/Pre Certification/Concurrent Reviews/Peer to Peer Calls/First Level Appeals/Special Projects and Committee participation when needed
Provide clinical expertise and business direction in support of medical management programs
Direct case management when necessary
Act as lead business and clinical liaison to network providers and facilities

Requirements:

Active and current state medical license without encumbrances
M.D. or D.O., 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
Board Certification in Internal Medicine, Family Medicine, Surgery Specialty

What we offer:

Affordable medical plan options
a 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:
June 06, 2025

Expiration:
June 27, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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