Medical Director

CVS Health

Medical Director in CVS Health's Medical Affairs providing clinical oversight and consultative support. Requires clinical experience and direct patient care expertise.

Posted 6/16/2026full-timeRemote • Arizona, Iowa, Minnesota, Texas • 🇺🇸 United StatesLead💰 $174,070 - $374,920 per yearWebsite

About the role

Key responsibilities & impact

model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making
transacts Utilization Management (UM) activities (prior authorization and appeals)
responds to prescriber inquiries related to UM transactions and CVS Health coverage policies
report to a Senior Medical Director in the Medical Affairs Department
provide consultative clinical support to Account Management in support of Key Clients as assigned
complete assigned medication utilization reviews and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate
participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions
provide oversight of a portion of CVS Health's clinical programs and commercial client program support
perform special clinical investigations and research as requested by the Senior Medical Director

Requirements

What you’ll need

Family Medicine or Internal Medicine Board Certification REQUIRED.
Minimum of 5 years clinical experience in direct patient care.
2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs
Unrestricted license to practice medicine in the state in which the candidate is located.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical integrityUtilization Managementprior authorizationmedical necessity appealsclinical investigationsmedical statisticsanalytic programs

Soft Skills

cross functional thinkingdecision makingconsultative supportquality oversight

Certifications

Family Medicine Board CertificationInternal Medicine Board Certificationunrestricted medical license