Medical Director (Medical Affairs)

The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned.

The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies.

Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise's decisions and planning.

- Each Director is responsible for providing oversight of a portion of CVS Health's clinical programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews.

- Directors will spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate.

- Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (i.e., Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage.

-In this role you'll perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of published literature around specific pharmaceutical questions or more in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Department. CVS Health, a Fortune 4 company, has an outstanding opportunity for a Medical Director (Medical Affairs).

Required Qualifications
* Family Medicine or Internal Medicine Board Certification. Minimum of 5 years clinical experience in direct patient care.

2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs

Unrestricted license to practice medicine in the state in which the candidate is located.

Preferred Qualifications
* Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as a teammate (e.g., RNs, PharmDs, etc.). ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine) Master's Degree in Public Health Administration or MBA preferred, UM/QA certification desired

Proficiency in MS Office Suite

Education
* Must be graduate of an accredited Medical School and Residency Program

Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia

Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employmentPay 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.