Medical Director – Commercial

CVS Health

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

Posted 11/4/2026full-timeRemote • United StatesLead💰 $174,070 - $374,920 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates clinical expertise and business direction in medical management programs, with a focus on effective execution and collaboration with clinical teams and network providers. Holds an active medical license and board certification in a recognized specialty, ensuring compliance and quality in patient care.

Highest-signal resume keywords

Clinical ExpertiseActive Medical LicenseBoard CertificationDirect 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 ManagementSpecial ProjectsCommittee ParticipationElectronic Medical SystemsPatient Care

Soft Skills

Effective CommunicationCollaborationLeadership

Certifications & Qualifications

M.D.D.O.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 PracticeManaged CareContinuum of Care

About the role

Key responsibilities & impact

Participate in the development, implementation, and evaluation of clinical/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 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 post-residency/fellowship experience in a health care delivery system, such as clinical practice or 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

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program
Equity award program