Medical Director -Spine

CVS Health; Connecticut; Hybrid; USD 174,000 - 375,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health, a Fortune 6 company, is seeking a Medical Director (Spine) to lead clinical governance and utilization review for orthopedics and neurosurgery. This remote role supports Aetna and CVS Health's medical management programs across the continuum of care.

The successful candidate will bring board-certified spine or neurosurgery expertise, active medical license, and strong collaboration with network providers to optimize patient outcomes and resource use.

Qualifications

• MD or DO with board certification in Orthopedic Spine OR Neurosurgery.
• Active and current state medical license.
• 2+ years of experience in Health Care Delivery System.

Responsibilities

• Lead utilization review and quality assurance activities.
• Direct case management and provide clinical expertise.
• Act as liaison to network providers and facilities.
• Handle predetermination reviews and claim determinations with clinical input.

Skills

Clinical Practice

Health Care Delivery

Education

MD/DO

Board Certification in Orthopedic Spine or Neurosurgery

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.

This role requires Board Certification in a Orthopedic Spine OR Neurosurgery.

This is a remote based (work at home) based anywhere in the US.

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.

Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home.

The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.

Expands Aetna's medical management programs to address member needs across the continuum of care.

Supports the Medical Management staff ensuring timely and consistent responses to members and providers.

Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.

Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.

Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer based applications.

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 a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.

Preferred Qualifications

• Previous healthcare insurance experience.

Education

• 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 a Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience.

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.

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. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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

We anticipate the application window for this opening will close on: 10/21/2026

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