Remote Medical Director: Policy & Utilization Leader

CVS Health; Harrisburg (Dauphin County); Remote; USD 174,000 - 375,000; Full time

Job summary

CVS Health's Aetna division seeks a Medical Director to oversee medical policy and contribute to clinical programs across the continuum of care. This remote role supports Medical Management staff and focuses on utilization review, QA, and predetermination reviews.

You will provide clinical expertise, participate in committee work, and liaise with network providers to ensure high-quality, compliant medical services.

Qualifications

• MD or DO and board-certified in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
• Active and current state medical license.

Responsibilities

• Oversee medical policy implementation.
• Develop, implement and evaluate clinical programs across the continuum of care.
• Support Medical Management staff ensuring timely responses to members and providers.
• Oversee utilization review, quality assurance and predetermination reviews.
• Lead business/clinical liaison to network providers for program execution.

Skills

MD/DO credential

Board Certification

Medical license

Education

MD or DO

Job description

CVS Health's Aetna division seeks a Medical Director to oversee medical policy and contribute to clinical programs across the continuum of care. This remote role supports Medical Management staff and focuses on utilization review, QA, and predetermination reviews.

You will provide clinical expertise, participate in committee work, and liaise with network providers to ensure high-quality, compliant medical services.