Medical Director – Medical Policy & Operations

CVS Health

. Provide clinical expertise to promote high-quality, constituent-focused medical care, with a focus on clinical and payment policy .

Posted 9/18/2026full-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 extensive clinical expertise in Health Care Delivery Systems, with a focus on clinical and payment policy, coding, and reimbursement. Proven ability to lead diverse teams and collaborate effectively to improve quality and efficiency in health care services.

Highest-signal resume keywords

Clinical ExpertiseHealth Care Delivery System ExperienceClinical Coding and ReimbursementActive Medical LicenseBoard Certification

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 CodingReimbursementHealth PolicyData AnalysisQuality ImprovementClinical Claim ReviewPredetermination of BenefitsHealth Care SystemsHCPCS CodingCPT Coding

Soft Skills

Strong Written CommunicationStrong Verbal Communication

Certifications & Qualifications

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

Industry Keywords

Health Care IndustryPayment PolicyClinical PracticeHealth PlanHealth Delivery Professionals

About the role

Key responsibilities & impact

Provide clinical expertise to promote high-quality, constituent-focused medical care, with a focus on clinical and payment policy
Perform transactional reviews supporting the appeal process, clinical claim review process, and predetermination of covered benefits in Commercial and Medicare environments
Provide subject matter expertise in clinical and payment policy to support clinical and business direction
Participate in work groups as a clinical subject matter expert to identify and promote opportunities to improve quality and efficiency of health care services
Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
Use data analysis to identify quality improvement opportunities and positively influence effective delivery of quality care services
Serve as a subject matter expert, internal consultant, and payment policy contributor
Work within and lead diverse teams of health delivery professionals to manage business objectives
Collaborate with functional areas

Requirements

What you’ll need

Five (5) or more years of experience in Health Care Delivery System, e.g., Clinical Practice and Health Care Industry
Active and current state medical license without encumbrances
M.D. or D.O.
Board Certification in an ABMS recognized specialty
Post-graduate direct patient care experience
Health plan/payor experience preferred
Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems preferred
Strong written and verbal communication skills preferred

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