Medical Director - Heartland

CVS Health; Topeka (KS); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading health solutions company is seeking a Medical Director for the Heartland region. This role involves overseeing medical policy, enhancing clinical programs, and ensuring effective health care delivery. Candidates must hold a valid medical license and possess significant experience in health care delivery systems.

Benefits

Affordable medical plan options

401(k) plan with company matching

Paid time off

Flexible work schedules

Tuition assistance

Qualifications

• Five (5) or more years of experience in Health Care Delivery System.
• Active and current medical license without encumbrances.
• M.D. or D.O., Active and Current Board Certification.

Responsibilities

• Provide oversight for medical policy implementation.
• Focus on utilization review and quality assurance.
• Act as lead clinical liaison to network providers.

Skills

Clinical Practice

Health Care Delivery

Medical Management

Education

Medical Doctor or Doctor of Osteopathic Medicine

Job description

Join to apply for the Medical Director - Heartland role at CVS Health

1 week ago Be among the first 25 applicants

Join to apply for the Medical Director - Heartland role at CVS Health

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 Heartland States (ND, SD, NE, IA, W. MO, CO, KS) and have a medical license without encumbrances in one of these states.

• In the Medical Director role you will provide oversight for medical policy implementation.
• You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
• You will support the Medical Management staff ensuring timely and consistent responses to members and providers.
• As a Medical Director you will focus primarily on overseeing utilization review and quality assurance while being responsible for predetermination reviews and review of claim determinations.
• This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
• The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
• In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• The Medical Director will 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.
  
  

Required Qualifications

• Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
• Active and current medical license without encumbrances
• M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
  
  

Preferred Qualifications

Previous UM experience with a Health Plan / Payor/ Physician Advisor in a Healthcare system.

Board Certification in Internal Medicine, Family Medicine, Emergency Medicine or Med / Peds / General Surgery Preferred.

Education

Medical Doctor or Doctor of Osteopathic Medicine

Pay Range

The Typical Pay Range For This Role Is

$174,070.00 - $374,920.00

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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: 07/04/2025

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

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at CVS Health by 2x

Sign in to set job alerts for “Medical Director” roles.

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.