Medical Director - New England Region

CVS Pharmacy; Hartford (CT); Remote; USD 174,000 - 375,000; Full time

Job summary

CVS Pharmacy seeks a Medical Director for the remote New England Region. This role focuses on overseeing utilization reviews and participating in clinical programs, requiring an active medical license and significant experience in health care delivery systems. The ideal candidate will exemplify teamwork and collaboration within their duties.

Benefits

401(k) plan with company matching contributions

Employee stock purchase plan

Wellness screenings and tobacco cessation programs

Flexible work schedules

Tuition assistance

Qualifications

• Active medical license without encumbrances.
• Two or more years of experience in Health Care Delivery System.
• M.D./D.O. with board certification in recognized specialty.

Responsibilities

• Oversee utilization review and quality assurance of inpatient hospitalizations.
• Support Medical Management staff in ensuring timely responses.
• Participate in development, implementation, and evaluation of clinical medical programs.

Skills

Clinical Practice

Health Care Delivery

Utilization Management

Collaboration

Teamwork

Education

Medical Doctor or Doctor of Osteopathic Medicine

Job description

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

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, Maine.

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.

There will be some weekend and holiday call required as part of the New England Team. This will be scheduled well in advance and all of the Medical Directors will be a part of the rotation.

The Medical Director will be responsible for overseeing the utilization review for health systems and providers in New England. 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 assurance 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.

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.

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, visithttps://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 08/28/2025

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