[Hiring] Medical Director, Medical Affairs @CVS Health

Role Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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.

Medical Directors are responsible for:

• Reviewing a broad range of clinical cases and coverage requests, including specialty medications, oncology therapies, biologics, and newly marketed drugs.
• Applying current medical literature and evidence-based guidelines.
• Synthesizing complex clinical information and assessing the strength of available evidence.
• Making objective, well-supported coverage determinations that are clinically appropriate, consistent, and evidence based.

The Medical Director will report to a Senior Medical Director in the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role, you may provide consultative clinical support to Account Management in support of Key Clients as assigned.

Directors will spend a portion of most days completing assigned medication utilization reviews and/or medical necessity appeals for:

• Commercial clients
• Governmental (Medicare/Medicaid) programs
• Individual client requested coverage determinations or appeals when appropriate.

Peer to peer conversations may be required at times. If specifically assigned to one business segment (i.e., Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage.

Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions.

Each Director may be responsible for:

• Providing oversight of a portion of CVS Health's clinical programs and commercial client program support.
• Sharing in reviews of utilization management criteria and clinical policy revisions/reviews.

Medical Directors may perform a share of special clinical investigations and research as requested by the Senior Medical Director. These projects can include:

• Brief reviews of published literature around specific pharmaceutical questions.
• More in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Department.

Qualifications

• ABMS or AOA Board Certified in Internal medicine or Family Medicine. CURRENT 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, including adequate clinical experience in direct patient care and working with professionals at different levels as teammates (e.g., RNs, PharmDs, etc.).
• 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.

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: 11/30/2026.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.