Executive Medical Director - Medical Policy & Operations

Hispanic Alliance for Career Enhancement; Remote; EUR 193.000 - 418.000; Vollzeit

Zusammenfassung

A leading health solutions company seeks an Executive Medical Director to lead a team focused on medical policy and operations. This role requires extensive clinical experience and health plan expertise. The ideal candidate will collaborate across various business units, ensuring high-quality healthcare delivery. Key qualifications include an MD or DO, medical director board certification, and experience with Aetna's systems and policies. This position offers a competitive salary and benefits including extensive health plans, 401(k) matching, and wellness programs.

Leistungen

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and programs

Tuition assistance

Flexible work schedules

Qualifikationen

• Five or more years of experience in clinical practice.
• Three or more years of health plan/payor experience.
• Active and current state medical license without encumbrances.

Aufgaben

• Lead a team providing clinical expertise in medical management programs.
• Collaborate on clinical and payment policies development.
• Drive better clinical and business outcomes across multiple business units.

Kenntnisse

Clinical practice expertise

Health plan/payor experience

Knowledge of Aetna Clinical and Payment Policy

Experience with Aetna transactional tools

Recruitment and training ability

Ausbildung

MD or DO

Tools

MedCompass

MedHok

CATS

ATV

TPS

FastKeys

Jobbeschreibung

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

This Executive Medical Director – Medical Policy & Operations leads a team responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This leader collaborates in the development and execution of clinical and payment policies to ensure the accurate administration of plan benefits for medically appropriate services. This Executive Director works across Aetna in a highly collaborative partnership with multiple business units to drive better clinical and business outcome.

Required Qualifications

• Five (5) years or more of experience in clinical practice.
• Three (3) years or more of health plan/payor experience.

Licenses

• Medical Director Board Certification is required.
• Active and current state medical license without encumbrances.

Preferred Qualifications

• Deep knowledge of Aetna Clinical and Payment Policy.
• Deep experience with Aetna transactional tools including MedCompass, MedHok, CATS, ATV, TPS.
• Expertise in digital tools like FastKeys.
• Demonstrated ability to recruit, train, and retain Medical Directors.
• Deep knowledge of Clinical Claim Review policy, procedure, and workflows.

Education

MD or DO

Pay Range

The typical pay range for this role is:
$227,630.00 – $490,280.00
This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 01/30/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.