Medical Director, CVS Health

Medical Director

CVS Health

Location:
United States, Remote (New England Region)

Category:
-

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

Medical Director position responsible for overseeing utilization review for health systems and providers in New England region. This is a remote position requiring collaboration with the New England Medical Director team, with some weekend and holiday call rotation required.

Job Responsibility:

Overseeing utilization review for health systems and providers in New England
Performing in-hospital utilization reviews and other quality activities
Overseeing utilization review and quality assurance of inpatient hospitalizations, prior authorizations, and appeals
Participating in the development, implementation, and evaluation of clinical / medical programs
Expanding medical management programs to address member needs across the continuum of care
Supporting Medical Management staff ensuring timely responses to members and providers
Handling Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals

Requirements:

Two (2) 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:

Residence in one of the states in the New England Region
Previous UM experience with a Health Plan / Payor
Previous UM experience as a Physician Advisor in a Health / Hospital system
Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine

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
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 31, 2025

Expiration:
September 19, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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