Medical Director, Medical Affairs

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Review clinical cases and coverage requests, which include specialty medications, oncology treatments, biologics, and newly introduced drugs.

• Identify, assess, and apply current medical literature along with evidence-based guidelines.

• Synthesize intricate clinical information and evaluate the strength of existing evidence.

• Make objective and well-supported coverage determinations.

• Offer clinical support and consultative services throughout the PBM.

• Provide consultative clinical assistance to Account Management for assigned key clients.

• Complete medication utilization reviews and/or medical necessity appeals for commercial, Medicare, Medicaid, and individual clients as assigned.

• Engage in peer-to-peer discussions when necessary.

• Support other business segments during evening and weekend coverage when assigned to one segment.

• Participate in inter-rater review activities and quality oversight processes.

• Oversee portions of CVS Health’s clinical programs and support for commercial clients.

• Participate in the review of utilization management criteria and revisions of clinical policies.

• Conduct special clinical investigations and research.

• Review pharmaceutical literature and collaborate with pharmacists in Medical Affairs and other business units.

• Act as a clinical decision-making and professional thought partner across enterprise decisions and planning.

⛳️ Requirements

• Board Certification in Family Medicine or Internal Medicine is REQUIRED.

• At least 5 years of clinical experience in direct patient care.

• A minimum of 2 years of demonstrated experience in clinical outcomes.

• Comprehensive understanding of medical statistics, regulatory agencies, and analytical programs.

• An unrestricted license to practice medicine in the state where the candidate is based.

• Graduate from 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) must be up to date and candidates must remain current in medical and management areas throughout employment.

• Additional subspecialty board certification is highly preferred.

• A combination of five years of management and/or clinical experience in a managed care setting and health administration is preferred.

• ABMS or AOA Board Certified in Internal Medicine or Family Medicine.

• Master’s Degree in Public Health Administration or MBA is preferred.

• UM/QA certification is desired.

• Proficiency in MS Office Suite is required.

🏝️ Benefits

• 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.

• Additional resources supporting physical, emotional, and financial well-being.