Medical Director - New England Region

9025 CVS Shared Services Resources LLC; Connecticut; Hybrid; USD 174,000 - 375,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Medical Director (Remote, New England Region) to oversee utilization review and quality evaluation for health systems in the region. The ideal candidate has ongoing medical licensure and ABMS/AOA board certification, with experience in in-hospital utilization reviews and quality initiatives.

Responsibilities include developing and evaluating clinical programs, collaborating with Medical Management staff, and leading prior authorizations, appeals, and related activities.

Qualifications

• Two 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 in an ABMS or AOA recognized specialty.

Responsibilities

• Oversee utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals.
• Develop, implement, and evaluate clinical/medical programs and expand medical management in the New England Region.
• Support Medical Management staff ensuring timely and consistent responses to members and providers.

Skills

Healthcare experience

MS Outlook

MS Teams

Education

MD/DO

ABMS/AOA 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 ourselves accountable 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 for the New England Region. The preferred candidate will reside in Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, or Maine. Even if the candidate does not reside in New England, the candidate should have the ability to learn about the New England market – hospitals, outpatient networks, and value-based care relationships.

The Medical Director will be responsible for overseeing the utilization review for health systems in the New England Region. An ideal candidate would have experience performing in-hospital utilization reviews and other quality activities. The Medical Director will be required to have a New England state medical license without encumbrances or the ability to obtain the license within a reasonable timeframe. Collaboration and teamwork are the defining characteristics of The New England Medical Director team; in order to be a successful member of the team the candidate must exemplify these qualities.

As a Medical Director you will focus primarily on overseeing utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals. 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. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.

Required Qualifications

• Two (2) 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.
• Experience with technology such as Microsoft Outlook and Teams.

Preferred Qualifications

• Residence in one of the states in the New England Region
• 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 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.

Benefits

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.

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

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

Application Window

We anticipate the application window for this opening will close on: 11/26/2026

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

Company Culture

Our Work Experience is the combination of everything that’s unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.