Job Description

Overview Join to apply for the Medical Director (Medical Affairs) role at CVS Health . This is a remote-based, work-from-home opportunity within CVS Health, a Fortune 6 company. The Medical Affairs department provides clinical business support to the enterprise and oversight for clinical programs, formulary development, drug information services, and leadership across internal departments and clients. Medical Directors model clinical integrity and cross-functional decision making as partners across the enterprise. Note: This description reflects the responsibilities and qualifications typically associated with the role; refer to the official posting for the most current details. Responsibilities Provide clinical support and consultative activities across CVS Health’s PBM and related programs. Offer consultative clinical support to Account Management in support of Key Clients as assigned. Transact Utilization Management (prior authorization and appeals) activities and respond to prescriber inquiries related to UM transactions and CVS Health coverage policies. Participate in reviews of utilization management criteria and clinical policy revisions; oversee portions of CVS Health’s clinical programs and commercial client program support. Perform assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial, governmental (Medicare/Medicaid) programs, and other client-determined cases as appropriate. Engage in inter-rater review and other quality oversight processes for internal UM decisions; gain proficiency in various UM programs to support multiple segments as assigned. Contribute to special clinical investigations and research projects, including literature reviews and collaborations with pharmacists and other departments as needed. Required Qualifications Family Medicine or Internal Medicine Board Certification. Minimum of 5 years of clinical experience in direct patient care. 2+ years of proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs. Unrestricted medical license in the state of residence. Preferred Qualifications Combination of five years of management and/or clinical experience in a managed care environment and health administration, including direct patient care and collaboration with professionals at different levels (e.g., RNs, PharmDs). ABMS or AOA Board Certification in a recognized medical specialty (preferably Primary Care: Internal Medicine or Family Medicine). Master’s in Public Health Administration or MBA; UM/QA certification desired. Proficiency in MS Office Suite. Education Graduate of an accredited medical school and residency program. Unrestricted active medical license in the applicable state/territory/DC. Required annual CME up to date and ongoing in medical and management areas during employment. Pay The Typical Pay Range For This Role Is $174,070.00 - $374,920.00. This range represents base pay; actual offer depends on experience, education, geography and other factors. Eligible for CVS Health bonus, commission or short-term incentives, and equity awards. Our people fuel our future. We are committed to a workplace where every colleague feels valued and belongs. Benefits Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for wellness, counseling, and financial coaching. Comprehensive benefits addressing diverse needs and preferences, including paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, retiree medical access, and more. For more information, visit the CVS Health benefits page. Application window is expected to close on: 10/31/2025. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws. #J-18808-Ljbffr CVS Health

Job Tags

Similar Jobs