This is a remote based (work from home) role preferably resides in Florida and preferably has a Florida medical license. In the Medical Director role you will:
- Provide oversight for medical policy implementation.
- You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
- You will support the Medical Management staff ensuring timely and consistent responses to members and providers.
As a Medical Director you will:
- Focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews and reviews of claim determinations.
- This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
- The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
- In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
- The Medical Director will act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
Required Qualifications:*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 (FL preferred)
*M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
Preferred Qualifications:Previous UM experience with a Health Plan / Payor.
Education:MD or DO
Pay RangeThe typical pay range for this role is:
$174,070.00 - $374,920.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 09/30/2026
