Medical Director – Ortho/Total Joint

CVS Health

Medical Director specializing in Orthopedics remotely at CVS Health. Lead medical management programs and ensure quality patient care across the continuum.

Posted 7/2/2026full-timeRemote • Connecticut • 🇺🇸 United StatesLead💰 $174,070 - $374,920 per yearWebsite

About the role

Key responsibilities & impact

Support Medical Management staff ensuring timely and consistent responses to members and providers.
Lead all aspects of utilization review/quality assurance, directing case management.
Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

Requirements

What you’ll need

2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Active and current state medical license without encumbrances
M.D. or D.O., Board Certification in an Orthopedic specialty including post-graduate direct patient care experience specifically
Previous healthcare insurance experience.

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 PracticeCase ManagementPredetermination ReviewsClaim Determination ReviewsCoding ExpertiseReimbursement Expertise

Soft Skills

CommunicationLeadership

Certifications

Active State Medical LicenseM.D.D.O.