Medical Director – Commercial

CVS Health

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

Posted 11/6/2026full-timeRemote • Connecticut • 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, with a strong focus on patient care and effective execution of medical services. Possesses extensive experience in health care delivery systems and a commitment to addressing member needs across the continuum of care.

Highest-signal resume keywords

M.D. Or D.O.Active State Medical LicenseBoard Certification In A Recognized SpecialtyDirect Patient Care ExperienceManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Program DevelopmentPrior AuthorizationPre-CertificationConcurrent ReviewsPeer To Peer CallsCare ManagementFirst Level AppealsElectronic Medical Systems ExperiencePost-Graduate Direct Patient Care ExperienceCommittee Participation

Soft Skills

Effective CommunicationCollaborationLeadership

Certifications & Qualifications

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

Industry Keywords

Health Care Delivery SystemMedical Management ProgramsClinical PracticeContinuum Of CareNetwork ProvidersFacilitiesMember NeedsClinical Team Activities

About the role

Key responsibilities & impact

Participate in the development, implementation, and evaluation of clinical and medical programs
Expand Aetna's medical management programs to address member needs across the continuum of care
Support Medical Management staff in 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, Care Management, special projects, and committee participation as needed
Provide clinical expertise and business direction for medical management programs 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

At least 3 years of experience post residency/fellowship 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
Five or more years of direct patient care experience preferred
Electronic medical systems/record experience preferred
Managed Care experience preferred
Board certification in Internal Medicine, Family Medicine, Emergency Medicine, General Surgery, or other surgery specialties preferred
Preferred working time zone of EST or CST

Benefits

Comp & perks

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