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Medical Director – Pain Management
CVS HealthMedical Director at CVS Health providing expertise in pain management and leading medical management initiatives. Remote position available for qualified candidates within the US.
Posted 7/14/2026full-timeRemote • Connecticut • 🇺🇸 United StatesLead💰 $174,070 - $374,920 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates clinical leadership and expertise in medical management, with a focus on utilization management, quality assurance, and regulatory compliance. Possesses strong clinical judgment in medical coding, reimbursement, and coverage policies, alongside effective collaboration with healthcare providers.
Highest-signal resume keywords
Clinical LeadershipUtilization ManagementQuality AssuranceMedical CodingRegulatory Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical PracticeHealth Care Delivery SystemMedical Necessity ReviewsCase ManagementPredetermination ReviewsClaim Determination ReviewsEvidence-Based ResponsesStrategic Decision-MakingPost-Graduate Direct Patient CarePain Management Specialty
Soft Skills
CollaborationConsultationGuidance
Certifications & Qualifications
Active State Medical LicenseBoard Certification in Pain Management
Industry Keywords
Medical ManagementInterdisciplinary Clinical TeamHealthcare FacilitiesMedical Services ProgramsQuality Outcomes
About the role
Key responsibilities & impact- Provide clinical leadership and expertise to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers.
- Lead utilization management and quality assurance activities, including oversight of medical necessity reviews and case management initiatives.
- Support medical management programs through active participation in interdisciplinary clinical team activities and strategic decision-making.
- Serve as the primary clinical and business liaison to network providers and healthcare facilities, fostering collaboration and supporting the effective implementation of medical services programs.
- Conduct predetermination reviews and claim determination reviews, applying clinical judgment and expertise in medical coding, reimbursement, and coverage policies.
- Provide guidance and consultation on complex clinical cases, helping ensure quality outcomes and regulatory compliance.
- Support the development and continuous improvement of medical management strategies, policies, and processes.
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 Pain Management specialty including post-graduate direct patient care experience specifically
Benefits
Comp & perks- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- comprehensive benefits package