Medical Director, Medical Affairs

CVS Health Careers

. Review clinical cases and coverage requests, including specialty medications, oncology therapies, biologics, and newly marketed drugs .

Posted 10/30/2026full-timeRemote • Illinois • United StatesLead💰 $174,070 - $374,920 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical decision-making and evidence-based guidelines, with a strong foundation in medical statistics and regulatory compliance. Capable of providing consultative clinical support and conducting medication utilization reviews across various healthcare settings.

Highest-signal resume keywords

Family Medicine Board CertificationInternal Medicine Board CertificationClinical Outcomes ExperienceUnrestricted Medical LicenseContinuing Medical Education (CME)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Case ReviewMedication Utilization ReviewEvidence-Based Guidelines ApplicationClinical InvestigationsMedical Statistics Understanding

Soft Skills

Consultative SupportCollaborative CommunicationObjective Decision-Making

Tools & Technologies

MS Office Suite

Certifications & Qualifications

ABMS Board CertificationAOA Board CertificationUM/QA Certification

Industry Keywords

Managed CarePharmaceutical Literature ReviewClinical Policy RevisionsQuality Oversight ProcessesHealth Administration

About the role

Key responsibilities & impact

Review clinical cases and coverage requests, including 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 the strength of available evidence
Make objective, well-supported 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/or medical necessity appeals for commercial, Medicare, Medicaid, and individual clients
Participate in peer-to-peer conversations when required
Support other business segments during evening and weekend coverage when assigned to one segment
Participate in inter-rater review activities and quality oversight processes
Provide oversight of portions of CVS Health’s clinical programs and commercial client program support
Share in reviews of utilization management criteria and clinical policy revisions
Perform special clinical investigations and research
Review pharmaceutical literature and collaborate with pharmacists within Medical Affairs and other business units
Participate as a clinical decision-making and professional thought partner across enterprise decisions and planning

Requirements

What you’ll need

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
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 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
Master’s Degree in Public Health Administration or MBA preferred
UM/QA certification desired
Proficiency in MS Office Suite

Benefits

Comp & perks

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