Medical Director - Midland States

CVS Health Corporation; Springfield (IL); Remote; USD 174,000 - 375,000; Full time

Job summary

CVS Health Corporation is seeking a Medical Director for a remote-based role, ideally in IL, MO, MN, or WI. You will oversee medical policy implementation and contribute to the expansion of medical management programs to address member needs across the care continuum.

You will lead clinical teams, provide expertise in coding and reimbursement, and coordinate with providers and facilities to ensure effective execution of medical services programs. MD/DO with board certification is required.

Qualifications

• Five or more years of experience in health care delivery systems.
• Active and current medical license without encumbrances.
• MD or DO with board certification including post‑graduate direct patient care.

Responsibilities

• Provide oversight for medical policy implementation.
• Develop, implement, and evaluate clinical/medical programs across care continuum.
• Support Medical Management staff with timely responses to members and providers.
• Oversee utilization review, QA, predetermination reviews, and claim determinations.
• Lead Prior Auth, Pre Certification, Concurrent Reviews, Peer to Peer calls, and appeals.

Skills

Healthcare knowledge

Clinical expertise

Education

MD/DO with board certification

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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 Midlands States (IL, MO, MN, WI) 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/31/2026

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