Medical Director

CVS Health

. Oversee utilization review for health systems in the Georgia and Gulf States region .

Posted 11/11/2026full-timeRemote • 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 utilization review and medical management within health systems, with a focus on quality evaluation and member care across the continuum. Holds an active medical license and board certification, ensuring compliance with healthcare standards and practices.

Highest-signal resume keywords

Utilization ReviewMedical ManagementActive Medical LicenseBoard CertificationClinical Practice Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewQuality EvaluationPrior AuthorizationPre-CertificationConcurrent ReviewsPeer-To-Peer CallsFirst-Level AppealsPost-Graduate Direct Patient Care

Soft Skills

CollaborationCommunicationTimely Response

Tools & Technologies

Microsoft OutlookMicrosoft Teams

Certifications & Qualifications

M.D.D.O.Board Certification in ABMS or AOA Specialty

Industry Keywords

Health Care Delivery SystemUtilization ManagementHealth Plan/PayorPhysician AdvisorInpatient Hospitalizations

About the role

Key responsibilities & impact

Oversee utilization review for health systems in the Georgia and Gulf States region
Oversee utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals
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 with timely and consistent responses to members and providers
Conduct or oversee prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, first-level appeals, and special projects
Participate in committees as needed
Collaborate and work as part of the Medical Director team

Requirements

What you’ll need

Two (2) or more years of experience in a health care delivery system, such as clinical practice and the health care industry
Active and current medical license without encumbrances
M.D. or D.O.
Active and current board certification in an ABMS- or AOA-recognized specialty
Post-graduate direct patient care experience
Experience with Microsoft Outlook and Teams
Preferred: residence in Louisiana, Mississippi, Alabama, or Arkansas
Preferred: previous utilization management experience with a health plan/payor
Preferred: previous utilization management experience as a Physician Advisor in a health/hospital system
Preferred: board certification in Internal Medicine, Family Medicine, or Emergency Medicine

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