Medical Director, Medical Affairs

Job not on LinkedIn

🔥 1 hour ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review clinical cases and coverage requests involving specialty medications, oncology therapies, biologics, and newly marketed drugs • Identify, evaluate, and apply current medical literature and evidence-based guidelines • Synthesize complex clinical information and assess available evidence • Make objective, clinically appropriate, consistent, and evidence-based coverage determinations • Provide clinical support and consultative activities across the PBM • Provide consultative clinical support to Account Management for assigned key clients • Complete assigned medication utilization reviews and medical necessity appeals for commercial, Medicare, Medicaid, and individual client coverage determinations • Participate in peer-to-peer conversations when required • Support other business segments with evening and weekend coverage when assigned to a specific segment • Participate in inter-rater review activities and quality oversight of internal Director utilization-management decisions • Provide oversight of portions of CVS Health clinical programs and commercial client program support • Participate in utilization-management criteria and clinical policy revisions and reviews • Conduct special clinical investigations and research requested by the Senior Medical Director • Review published literature and collaborate with pharmacists and business units on clinical projects • Report to a Senior Medical Director in the Medical Affairs Department

🎯 Requirements

• Family Medicine or Internal Medicine Board Certification is REQUIRED • Minimum of 5 years of clinical experience in direct patient care • 2 or more years proven experience in clinical outcomes • Solid understanding of medical statistics, regulatory agencies, and analytic programs • Unrestricted license to practice medicine in the state in which the candidate is located • Graduate of an accredited Medical School and Residency Program • 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 current during employment • Additional subspecialty board certification strongly preferred • Combination of five years of management and/or clinical experience in a managed care environment and health administration preferred • ABMS or AOA Board Certified in Internal Medicine or Family Medicine preferred • Master’s Degree in Public Health Administration or MBA preferred • UM/QA certification desired • Proficiency in MS Office Suite

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being

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