Executive Medical Director, Medical Affairs

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $184.1k - $396.6k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Oversee governance of Aetna’s centralized MD Quality function, ensuring alignment with enterprise standards and regulatory requirements • Lead a multidisciplinary team of Clinical and Admin Auditors, Trainers, Data Analyst, and Program Ops Manager • Analyze decision trends and variability to identify high-impact areas for targeted improvement • Evaluate audit methodologies and insights to ensure findings are actionable, defensible, and aligned with priorities • Lead MD Quality forums to set standards and drive transparency and cross-LOB alignment • Prioritize quality improvement and remediation efforts, focusing on highest-impact interventions • Oversee tracking of quality metrics and outcomes to ensure accountability and sustained improvement at individual and team levels • Represent MD Quality in executive forums, providing updates on performance trends, risks, and mitigation strategies • Serve as a trusted clinical advisor, advancing a culture of quality, rigor, and accountability • Own cross-functional partnership with ACS, driving end-to-end alignment and quality improvement • Shape the future-state MD Quality operating model • Advance review methodology, performance calibration, and governance for clinically sound MD decisions aligned with enterprise standards and member-first principles

🎯 Requirements

• 10+ years of clinical experience with progressive leadership in utilization management, medical policy, clinical operations, or quality oversight • Experience leading clinical quality review or MD performance calibration • Deep understanding of clinical coverage determinations, appeals, regulatory standards (e.g., CMS, NCQA), and medical necessity criteria • Experience developing structured training programs to improve performance • Demonstrated ability to influence senior clinical and business leaders in a complex, matrixed organization • Strong analytical skills, including interpretation of variability metrics, IRR results, and audit findings • Executive presence and communications skills, with experience presenting to senior leadership • Board certified MD or DO required • Training in healthcare quality, public health, health policy, or healthcare administration • Experience designing/transforming internal clinical quality or audit programs • Direct experience with IRR methodology and performance calibration frameworks • Familiarity with multiple lines of business (Commercial, Medicare, Medicaid) • Background in change management or leading enterprise-wide quality improvement initiatives

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s 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, based on eligibility