Medical Director – Commercial

CVS Health

. Participate in the development, implementation, and evaluation of clinical and medical programs .

Posted 9/23/2026full-timeRemote • North Carolina • 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 clinical expertise and business direction in medical management programs, ensuring effective execution and support for clinical teams. Possesses strong experience in health care delivery systems and utilization management.

Highest-signal resume keywords

Active State Medical LicenseM.D. or D.O.Board Certification in a Recognized SpecialtyUtilization Management ExperienceDirect Patient Care Experience

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 Program DevelopmentPrior AuthorizationPre-CertificationConcurrent ReviewsPeer-to-Peer CallsFirst-Level AppealsClinical Team ParticipationMedical Management Support

Soft Skills

Effective CommunicationCollaboration with Providers

Tools & Technologies

Electronic Medical SystemsElectronic Medical Records

Certifications & Qualifications

Board Certification in Internal MedicineBoard Certification in Family MedicineBoard Certification in Emergency MedicineBoard Certification in General Surgery

Industry Keywords

Health Care Delivery SystemManaged CareClinical PracticeHealth Plan/Payor

About the role

Key responsibilities & impact

Participate in the development, implementation, and evaluation of clinical and medical programs
Expand Aetna medical management programs to address member needs across the continuum of care
Support Medical Management staff by ensuring timely and consistent responses to members and providers
Conduct or support prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, first-level appeals, special projects, and committee participation as needed
Provide clinical expertise and business direction through participation in clinical team activities
Act as lead business and clinical liaison to network providers and facilities
Support effective execution of medical services programs by clinical teams

Requirements

What you’ll need

2 or more years of experience in a health care delivery system, such as clinical practice and the health care industry
Active and current state medical license without encumbrances
M.D. or D.O.
Board Certification in a recognized specialty
Post-graduate direct patient care experience
Preferred: Five or more years of direct patient care experience
Preferred: Previous utilization management experience with a health plan/payor
Preferred: Electronic medical systems/record experience
Preferred: Managed Care experience
Preferred: Board certification in Internal Medicine, Family Medicine, Emergency Medicine, or General Surgery

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