Medical Director

CVS Health; Phoenix (AZ); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading health solutions company is seeking a Medical Director to oversee medical policy implementation and support clinical programs. This remote role requires a medical license in Arizona and offers a competitive salary range. Ideal candidates will have significant experience in healthcare delivery and a strong clinical background.

Benefits

Medical plans

401(k)

Stock purchase plans

Wellness programs

Paid time off

Flexible schedules

Family leave

Tuition assistance

Qualifications

• Two or more years of experience in Health Care Delivery System.
• Active and current medical license without encumbrances.

Responsibilities

• Provide oversight for medical policy implementation.
• Support Medical Management staff ensuring timely responses.
• Oversee utilization review and quality assurance.

Skills

Clinical Practice

Health Care Delivery System

Education

Medical Doctor

Doctor of Osteopathic Medicine

Job description

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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

Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

This is a remote-based (work from home) position. Ideal candidates will reside in Arizona and have a medical license without encumbrances.

In This Role You Will

• Support Mercy Care
• Provide oversight for medical policy implementation.
• Participate in the development, implementation, and evaluation of clinical/medical programs and expand medical management programs to address member needs across the continuum of care.
• Support Medical Management staff ensuring timely and consistent responses to members and providers.
• Oversee utilization review and quality assurance, including predetermination reviews and review of claim determinations.
• Handle Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation as needed.
• Provide clinical, coding, and reimbursement expertise and direct case management when necessary.
• Contribute clinical expertise and business direction in support of medical management programs through clinical team activities.
• Act as lead business and clinical liaison to network providers and facilities to support effective medical services programs.
• Participate in a weekend, holiday, and on-call rotation.

Required Qualifications

• Two (2) or more years of experience in Health Care Delivery System, e.g., Clinical Practice and Healthcare Industry.
• Active and current medical license without encumbrances.
• M.D. or D.O., with active and current Board Certification in an ABMS or AOA recognized specialty, including post-graduate direct patient care experience.
• Overnight travel up to 10%.
• AZ medical license without encumbrances.

Preferred Qualifications

• Previous UM experience with a Health Plan / Payor.
• Previous UM experience as a Physician Advisor in a Health / Hospital system.
• Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine.

Education

Medical Doctor or Doctor of Osteopathic Medicine.

Pay Range

The typical pay range for this role is $174,070.00 - $374,920.00. Actual offers depend on experience, education, geography, and other factors. The role is eligible for bonuses, incentives, and equity awards.

Benefits

Our benefits include medical plans, 401(k), stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, and more. For details, visit https://jobs.cvshealth.com/us/en/benefits.

Application deadline: 05/16/2025.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals and Health Care