Medical Director, Population Health & Utilization

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an MD/DO‑level Medical Director for the Aetna One Advocate team to lead high‑touch clinical management and utilization decisions. You will guide predeterminations, case management, and program development with a multidisciplinary, collaborative group of clinicians.

Expect 15% external engagement with plan sponsors and providers, with strong emphasis on clinical leadership, policy implementation, and operational impact within a fast‑moving team.

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 Aetna’s medical management programs to better 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 through active participation in clinical team activities
• Serve as lead clinical and business liaison to network providers and facilities, supporting effective execution of medical services programs
• Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings (approx. 15% of time)

Education

M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience

Job description

CVS Health is seeking an MD/DO‑level Medical Director for the Aetna One Advocate team to lead high‑touch clinical management and utilization decisions. You will guide predeterminations, case management, and program development with a multidisciplinary, collaborative group of clinicians.

Expect 15% external engagement with plan sponsors and providers, with strong emphasis on clinical leadership, policy implementation, and operational impact within a fast‑moving team.