Remote Medical Director, Utilization & Appeals

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

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Equity award program

Job summary

CVS Health is seeking a Medical Director to join a centralized COE team that supports precertification, concurrent review, and appeal requests for Aetna Integrated Plans. This full-time, remote role requires alignment with Eastern or Central time and coverage of occasional holidays and weekends.

The Medical Director will lead utilization management, participate in rounds, and oversee pharmacy coverage while ensuring timely, high-quality decisions across base plans.

Qualifications

• MD or DO with ABMS/AOA board certification.
• Active, current state medical license without encumbrances.
• 2+ years in managed care; 3-5 years clinical practice.
• Florida license or ability to obtain license.

Responsibilities

• Perform concurrent and prior authorization reviews with peer-to-peer discussion for denials.
• Process and manage appeals within base plans; coordinate round-robin as needed.
• Conduct pharmacy coverage reviews and contribute to formulary decisions.
• Participate in and/or lead medical rounds and discussions.

Skills

Clinical practice

Managed care experience

Medical licensure

Education

MD or DO

Job description

CVS Health is seeking a Medical Director to join a centralized COE team that supports precertification, concurrent review, and appeal requests for Aetna Integrated Plans. This full-time, remote role requires alignment with Eastern or Central time and coverage of occasional holidays and weekends.

The Medical Director will lead utilization management, participate in rounds, and oversee pharmacy coverage while ensuring timely, high-quality decisions across base plans.