Medical Director - (Ortho/Total Joint)

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

Job summary

Join a forward-thinking health solutions company as a Medical Director specializing in Orthopedics. This role offers the opportunity to lead medical management programs and enhance patient care across the continuum. With a focus on clinical quality and effective resource use, you will support a team dedicated to transforming healthcare delivery. Enjoy a competitive salary and comprehensive benefits while working remotely from anywhere in the US. If you're passionate about making a difference in healthcare, this role is perfect for you.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Confidential counseling

Financial coaching

Paid time off

Flexible work schedules

Tuition assistance

Qualifications

• 2+ years of experience in Health Care Delivery System.
• Active state medical license required.
• Experience in Orthopedic specialty with direct patient care.

Responsibilities

• Lead utilization review and quality assurance activities.
• Provide clinical expertise in medical management programs.
• Act as liaison to network providers for medical services.

Skills

Health Care Delivery System Experience

Clinical Practice

Orthopedic Specialty

Utilization Review

Education

M.D. or D.O. with Board Certification in Orthopedic Specialty

Job description

Join to apply for the Medical Director - (Ortho/Total Joint) role at CVS Health

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Join to apply for the Medical Director - (Ortho/Total Joint) 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, a Fortune 6 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 at home) based anywhere in the US.**

The Medical Director (Ortho/Total Joint) will be a Subject Matter Expert (SME) with a background in Orthopedic specialty, including post-graduate direct patient care experience specifically. This role expands Aetna's medical management programs to address member needs across the continuum of care. In this role you'll support the Medical Management staff ensuring timely and consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management. In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities You'll 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 In addition, you will be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise

Required Qualifications

• 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
• Active and current state medical license without encumbrances
• M.D. or D.O., Board Certification in an Orthopedic specialty including post-graduate direct patient care experience specifically
  
  

Preferred Qualifications

• Previous healthcare insurance experience.
  
  

Education

• M.D. or D.O., Board Certification in an Orthopedic specialty.
  
  

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: 06/30/2025

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

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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