We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Fundamental Components:
The Executive Medical Director provides clinical and operational leadership across Aetna and CVS enterprise initiatives focused on documentation accuracy, compliance, and medical management performance. The role partners across business units to improve clinical outcomes, support risk analysis activities, lead audit-related work, and strengthen key external relationships. This leader also oversees medical management programs and policies, leads the territory Senior Medical Directors, and drives execution against strategic and operational priorities.
Responsibilities include but can change as business needs dictate:
Leads, develops, and directs clinical and non-clinical activities that improve health care quality, cost, and outcomes
Directs the utilization review process and oversees the quality of utilization determinations
Ensures compliance with clinical goals by monitoring care management performance
Oversees unit medical policies to support appropriate, cost-effective care and day-to-day management of medical management staff
Recommends changes to managed care programs, review guidelines, and clinical criteria based on deep knowledge of care delivery, utilization, reimbursement, and treatment protocols
Develops, implements, and interprets medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments
Leads clinical staff (territory senior medical directors and transactional medical directors) in coordinating quality care and provides clinical expertise and business direction to support medical management programs
Serves as the lead business and clinical liaison to network providers and facilities to support effective execution of medical services programs
Expands Aetna medical management programs to address member needs across the continuum of care
Reviews and handles cases as needed
Provides weekend on-call coverage as needed
Travel potential 15–25%
Required Qualifications
3+ years of leadership experience in the Medicare line of business, or a related role
3+ years of clinical practice experience
3+ years of leadership experience in managed care
M.D. or D.O. with board certification in a recognized specialty and post-graduate direct patient care experience
Active, unrestricted state medical license
Preferred Qualifications
Demonstrated leadership experience in clinical operations, medical management, and utilization management
Education
MD or DO
Pay Range
The typical pay range for this role is:
$227,630.00 - $490,280.00
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 people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 3+ years of leadership experience in the Medicare line of business or a related role
- 3+ years of clinical practice experience
- 3+ years of leadership experience in managed care
- M.D. or D.O. with board certification in a recognized specialty and post-graduate direct patient care experience
- Active, unrestricted state medical license
- MD or DO (education)
- Demonstrated leadership experience in clinical operations, medical management, and utilization management
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
