Medical Director, Medical Affairs

CVS Health Careers

. Provide clinical support and consultative activities across the PBM .

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

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical support and consultative activities within pharmacy benefit management, with a strong focus on evidence-based coverage determinations and utilization management. Holds current board certification in Family Medicine or Internal Medicine and possesses extensive clinical experience in managed care environments.

Highest-signal resume keywords

Board Certification In Family MedicineClinical Experience In Direct Patient CareMedical Statistics UnderstandingUtilization Management ExperienceContinuing Medical Education (CME)

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical SupportEvidence-Based Coverage DeterminationsMedication Utilization ReviewClinical InvestigationsQuality Oversight ProcessesAnalytic ProgramsMedical Evidence EvaluationSpecialty Medications ReviewOncology Therapies KnowledgeBiologics Understanding

Soft Skills

Consultative SkillsCollaborationCommunication

Tools & Technologies

MS Office Suite

Certifications & Qualifications

ABMS Board CertificationAOA Board CertificationUM/QA CertificationCME Compliance

Industry Keywords

Pharmacy Benefit ManagementManaged CareMedicareMedicaidClinical OutcomesHealth AdministrationPublic Health AdministrationClinical Policy RevisionsPeer-to-Peer ConversationsQuality Assurance

About the role

Key responsibilities & impact

Provide clinical support and consultative activities across the PBM
Provide consultative clinical support to Account Management for assigned key clients
Review medication utilization requests and medical necessity appeals for commercial clients, Medicare/Medicaid programs, and individual client coverage determinations
Participate in peer-to-peer conversations when required
Support evening and weekend coverage across commercial, Medicare, and Medicaid segments as needed
Participate in inter-rater review activities and quality oversight processes for internal Director utilization-management decisions
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 and reviews
Perform special clinical investigations and research requested by the Senior Medical Director
Review published literature on pharmaceutical questions and collaborate with pharmacists within Medical Affairs and other business units
Review clinical cases and coverage requests involving specialty medications, oncology therapies, biologics, and newly marketed drugs
Synthesize clinical information, evaluate medical evidence, and make objective, evidence-based coverage determinations

Requirements

What you’ll need

ABMS or AOA Board Certified in Internal medicine or Family Medicine
CURRENT 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
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 employment
Proficiency in MS Office Suite
Additional subspecialty board certification is strongly preferred
Combination of five years of management and/or clinical experience in a managed care environment and health administration preferred
Master’s Degree in Public Health Administration or MBA preferred
UM/QA certification desired

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
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