Medical Director (Medical Policy & Operations)

CVS Health; United States; Remote; USD 174,000 - 375,000; Full time

Job summary

An innovative healthcare organization is seeking a Medical Director to lead clinical policy and operations. This remote position offers the chance to make a significant impact on patient care by providing clinical expertise and business direction. As a key player in enhancing healthcare quality, you will collaborate with diverse teams and leverage your knowledge in clinical coding and reimbursement. The role promises a competitive salary, comprehensive benefits, and the opportunity to contribute to meaningful healthcare improvements across the nation. If you are passionate about advancing patient-centered care, this position is perfect for you.

Benefits

Medical Coverage

Dental Coverage

Vision Coverage

401(k)

Employee Stock Purchase Plan

Life Insurance

Disability Benefits

Well-being Programs

Education Assistance

Store Discounts

Qualifications

• 5+ years of experience in healthcare delivery, including clinical practice.
• Active medical license and board certification required.

Responsibilities

• Support appeal processes and clinical claim reviews.
• Identify opportunities for improving healthcare quality and efficiency.

Skills

Healthcare Delivery

Clinical Practice

Coding (HCPCS/CPT)

Clinical Policy

Reimbursement

Data Analysis

Strong Communication Skills

Education

MD or DO degree

Board Certification in ABMS-recognized specialty

Job description

Position Summary

Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director. This is a remote Work at Home position, open to candidates anywhere in the United States.

As Medical Director MPO (Medical Policy & Operations), you will provide clinical expertise and business direction to support medical management programs aimed at delivering high-quality, patient-centered care with a focus on clinical and payment policies.

You will serve as a subject matter expert in clinical support and business direction, with knowledge of Aetna's clinical and coding policies, appeals, claim review, reimbursement issues, and coding—though a willingness to learn is essential.

Key responsibilities include supporting the appeal process, clinical claim review, pre-certification, and benefit determinations in both Commercial and Medicare environments. You will:

1. Participate in work groups as a clinical SME to identify and promote opportunities for improving healthcare quality and efficiency.
2. Apply clinical coding and reimbursement expertise to ensure policy and practice alignment.
3. Use data analysis proactively to identify quality improvement opportunities.
4. Serve as an internal consultant on payment policies and clinical support.
5. Lead or collaborate with diverse healthcare teams to meet business objectives.

Required Qualifications

• Five or more years of experience in healthcare delivery, including clinical practice or healthcare industry roles.
• Active, current medical license without encumbrances.
• MD or DO degree, with board certification in an ABMS-recognized specialty, including post-graduate direct patient care experience.

Preferred Qualifications

• Experience in health plans or payor organizations.
• Foundational skills in medicine, health policy, coding (HCPCS/CPT), clinical policy, reimbursement, and healthcare systems.
• Strong written and verbal communication skills.

Education

MD or DO, board-certified in an ABMS-recognized specialty with post-graduate clinical experience.

Pay Range

The typical pay range is $174,070 - $374,920 annually, depending on experience, education, and location. This role is eligible for bonuses, incentives, and equity awards.

In addition to salary, benefits include medical, dental, and vision coverage; 401(k); Employee Stock Purchase Plan; life insurance; disability benefits; well-being programs; education assistance; store discounts; and paid time off, including holidays and sick leave.

For more information, visit jobs.CVSHealth.com/benefits.