Executive Medical Director - Medical Policy & Operations
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary This Executive Medical Director - Medical Policy & Operations leads a team responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This leader collaborates in the development and execution of clinical and payment policies to ensure the accurate administration of plan benefits for medically appropriate services. This Executive Director works across Aetna in a highly collaborative partnership with multiple business units to drive better clinical and business outcome.
Required Qualifications
Background / Experience: Five (5) years or more of experience in clinical practice. Three (3) years or more of health plan/payor experience. Licenses:
- Medical Director Board Certification is required
- Active and current state medical license without encumbrances
Preferred Qualifications
Deep knowledge of Aetna Clinical and Payment Policy Deep experience with Aetna transactional tools including MedCompass, MedHok, CATS, ATV, TPS. Expertise in digital tools like FastKeys. Demonstrated ability to recruit, train, and retain Medical Directors Deep knowledge of Clinical Claim Review policy, procedure, and workflows. Education MD or DO Pay Range The typical pay range for this role is: $227,630.00 - $490,280.00 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 01/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job