Medical Director, Population Health & Utilization

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a high-level Medical Director with MD/DO credentials to oversee utilization management and clinical program development. The role blends leadership with external engagement, including plan sponsor presentations and strategic program expansion.

The ideal candidate will have board certification in a relevant specialty, be able to train on UM processes, and lead a multidisciplinary team of clinicians to improve member outcomes across care settings.

Qualifications

• Active, unrestricted MD required.
• Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or PM&R strongly preferred.
• No prior utilization management or managed care experience required – full training provided.
• Comfort and experience presenting to external audiences – strong public speaking and stakeholder communication skills.
• Collaborative mindset and comfort working in a close, fast-moving clinical team.

Responsibilities

• Lead utilization management, including predetermination and UM reviews.
• Apply clinical expertise to support accurate, consistent decisions.
• Participate in the development, implementation, and evaluation of clinical/medical programs.
• Help expand medical management programs to address member needs across the continuum of care.
• Support Medical Management staff in delivering timely, consistent responses to members and providers.
• Oversee utilization review and quality assurance activities.
• Direct case management efforts.
• Provide clinical expertise and business direction for medical management programs.

Skills

Public speaking

Collaborative mindset

Clinical leadership

Education

MD or DO

ABMS board certification

Job description

CVS Health is seeking a high-level Medical Director with MD/DO credentials to oversee utilization management and clinical program development. The role blends leadership with external engagement, including plan sponsor presentations and strategic program expansion.

The ideal candidate will have board certification in a relevant specialty, be able to train on UM processes, and lead a multidisciplinary team of clinicians to improve member outcomes across care settings.