[Hiring] Medical Director, Medical Affairs @CVS Health

Role Description

CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs). This is a full-time, remote based, work from home opportunity.

The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services and pipeline activities, and clinical leadership to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients.

Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge and cross functional thinking, and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise’s decisions and planning.

• Responsible for reviewing a broad range of clinical cases and coverage requests, including specialty medications, oncology therapies, biologics, and newly marketed drugs.
• Requires a strong clinical foundation, sound medical judgment, and the ability to efficiently identify, evaluate, and apply current medical literature and evidence-based guidelines.
• Must synthesize complex clinical information, assess the strength of available evidence, and make objective, well-supported coverage determinations that are clinically appropriate, consistent, and evidence-based.
• Reports to a Senior Medical Director in the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM.
• May provide consultative clinical support to Account Management in support of Key Clients as assigned.
• Completes assigned medication utilization reviews and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs, and individual client requested coverage determinations or appeals when appropriate.
• Participates in inter-rater review activities and other quality oversight processes for internal Director UM decisions.
• May be responsible for providing oversight of a portion of CVS Health's clinical programs and commercial client program support.
• May perform a share of special clinical investigations and research as requested by the Senior Medical Director.

Qualifications

• Family Medicine or Internal Medicine Board Certification is REQUIRED. Additional subspecialty board certification is strongly preferred.
• Minimum of 5 years of clinical experience in direct patient care.
• 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs.
• Unrestricted license to practice medicine in the state in which the candidate is located.

Preferred Qualifications

• Combination of five years of management and/or clinical experience in a managed care environment and health administration.
• ABMS or AOA Board Certified in Internal Medicine or Family Medicine.
• Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired.
• Proficiency in MS Office Suite.

Education

• Must be graduate of an accredited Medical School and Residency Program.
• Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia.
• Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employment.

Pay Range

The 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.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

We anticipate the application window for this opening will close on: 10/20/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.