CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Executive Medical Director
Location
United States
Posted
9 days ago
Salary
$227.6K - $490.3K / year
Seniority
Lead
No structured requirement data.
Job Description
Executive Medical Director
CVS Health
Role Description The Executive Medical Director provides clinical and operational leadership across Aetna and CVS enterprise initiatives focused on documentation accuracy, compliance, and medical management performance. The role partners across business units to improve clinical outcomes, support risk analysis activities, lead audit-related work, and strengthen key external relationships. This leader also oversees medical management programs and policies, leads the territory Senior Medical Directors, and drives execution against strategic and operational priorities. - Leads, develops, and directs clinical and non-clinical activities that improve health care quality, cost, and outcomes - Directs the utilization review process and oversees the quality of utilization determinations - Ensures compliance with clinical goals by monitoring care management performance - Oversees unit medical policies to support appropriate, cost-effective care and day-to-day management of medical management staff - Recommends changes to managed care programs, review guidelines, and clinical criteria based on deep knowledge of care delivery, utilization, reimbursement, and treatment protocols - Develops, implements, and interprets medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments - Leads clinical staff (territory senior medical directors and transactional medical directors) in coordinating quality care and provides clinical expertise and business direction to support medical management programs - Serves as the lead business and clinical liaison to network providers and facilities to support effective execution of medical services programs - Expands Aetna medical management programs to address member needs across the continuum of care - Reviews and handles cases as needed - Provides weekend on-call coverage as needed - Travel potential 15–25% Qualifications - 3+ years of leadership experience in the Medicare line of business, or a related role - 3+ years of clinical practice experience - 3+ years of leadership experience in managed care - M.D. or D.O. with board certification in a recognized specialty and post-graduate direct patient care experience - Active, unrestricted state medical license Preferred Qualifications - Demonstrated leadership experience in clinical operations, medical management, and utilization management 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. 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 Application Information We anticipate the application window for this opening will close on: 06/26/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Related Guides
Related Categories
Related Job Pages
More Medical Director Jobs
Senior Medical Director of Clinical Program Governance and Standardization
UnitedHealth GroupUnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Role Description The UHC Senior Medical Director of Clinical Program Governance & Standardization is part of the UCS Clinical Evidence Group. This physician is responsible for supporting and driving key clinical program governance, clinical standardization, and clinical evidence alignment processes in close collaboration with the National CMO of the UCS Clinical Evidence Group. The portfolio of efforts for which the incumbent will provide support, oversight, and leadership includes: - The UHC Clinical Program Governance process, which ensures deployed clinical programs are clinically sound, effective, carefully monitored, and advance enterprise goals. - The core process (Clinical Program Review (CPR)) evaluates ~50 clinical programs annually for program performance and design as well as alignment with member and health plan needs. - The process aims to optimize clinical program investments, ensuring that the portfolio reflects the best opportunity to improve health, enhance experience, and reduce unwarranted spending. - Support of early program development through the clinical program Ideation Front Door (IFD) process. - Clinical review of vendor candidates for the UHC & Optum Hub and Store (~40/year). - UHC’s participation in cross-industry efforts to advance standards and reduce friction for members and providers. The incumbent will report to the National CMO of the Clinical Evidence Group. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Qualifications - Masters level degree (or higher) in statistics, epidemiology, health services research or a related field. - Board certified physician in an ABMS/AOBMS Specialty. - Active/unrestricted U.S. Medical Licensure. - 5+ years of experience as a clinician (MD, DO or equivalent). - 3+ years of experience in health plan administration, health services research, quality assurance or comparable experience. - 3+ years serving as a consultant or leading a team on point for care quality improvement or product development and production. - Deep understanding of health plan medical policies, utilization management processes, and interpretation of data-rich reports related to utilization management programs. - Proficient in Excel, PowerPoint, Teams, Outlook and SharePoint. - Demonstrated ability to understand and efficiently interpret expansive data on clinical performance, program ID Strat (inclusion & exclusion criteria), financial impact data as well as program auditing and compliance review results. - Demonstrated ability to work collaboratively with clinicians, administrators and customers. - Demonstrated ability to drive process standardizations without suppressing creativity. - Demonstrated ability to navigate complex conversations with external partners, customers and providers who may challenge product specifications or analytic methods. - Demonstrated flexibility, agility and the ability to adapt to change while staying organized and maintaining solid relationships. Requirements - Experience with clinical program design, deployment and/or evaluation in the provider or payer setting. - Experience interacting with leaders across diverse members of the healthcare industry. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. Company Description At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.
• Identify, develop and implement the business strategy for the Medical Affairs and Pharmacovigilance departments • Develop and agree upon annual revenues, sales, profit and operational targets for the Medical Affairs and Pharmacovigilance departments • Evaluate and direct the organization's activities to achieve targets for trading performance, quality, culture and legislative adherence. • Develop and agree upon operating procedures / business processes • Preside as needed over (senior) management team meetings • Maintain and develop organizational culture, values, and reputation • Report to applicable stakeholders on business strategy planning, results and performance for the Medical affairs and Pharmacovigilance department • Act as the organization's representative in its dealings with the outside world • Manage direct reporting staff • Actively contribute to staff learning & development within the company • Monitor and assure client satisfaction on existing projects for the Medical Affairs and Pharmacovigilance department with related activities • Identify key accounts and maintain strong long-lasting relationships to win new and repeat business
Medical Records Clerk
CommonSpirit HealthCommonSpirit Health is a nonprofit organization that is on a mission to improve people’s health while making “the healing presence of God known.” The orga
Role Description As our Medical Records Professional, you will ensure the integrity, confidentiality, and accessibility of patient health information, meticulously managing records in compliance with all regulatory standards and organizational policies. - Accurately process, retrieve, and maintain patient medical records (electronic and paper). - Manage requests for Protected Health Information (PHI) ensuring strict HIPAA compliance. - Play a key role in ensuring the completeness, accuracy, and proper indexing of health information within the EHR system. - Manage incoming departmental telephone calls and faxes and respond as appropriate. - Maintain accurate physician contact lists. - Perform miscellaneous clerical duties based on departmental needs, such as: - Departmental mail distribution - Filing - Sorting - Copying - Record keeping - Posting - Tabulating information - Organizing assigned tasks - Maintain supply of documentation materials. - Deliver and pick up records, interoffice mail, etc. as needed. - Prepare and mail all outgoing patient correspondence and appropriate attachments. Qualifications - Strong understanding of medical terminology. - Knowledge of health information management principles. - Comprehensive knowledge of HIPAA and privacy regulations. - Meticulous attention to detail. - Strong organizational skills. - Proficiency with EHR systems. Requirements - High School Diploma or GED. - One (1) year clerical experience. - Familiarity with applicable alphabetic and numeric filing systems.
Medical Documenter/Tumor Documenter
Flatiron HealthFlatiron Health is a healthcare technology company founded in 2012 by Nat Turner and Zach Weinberg, two of the founders of the advertising technology firm Invite Media. The pair es
Role Description Wir suchen eine:n medizinische:n Tumordokumentar:in, der:die uns dabei hilft, unsere Mission zu erfüllen, Leben zu verbessern und zu verlängern, indem wir von den Erfahrungen eines jeden Menschen mit Krebs lernen. Bist Du bereit, den Wandel in der Behandlung von Krebserkrankungen mitzugestalten? Die Tätigkeit wird zunächst auf ein Jahr befristet und kann flexibel von zu Hause aus oder gegebenenfalls nach Absprache in unserem Büro in Berlin erbracht werden. Arbeitest du lieber früh morgens, nachmittags oder abends? Für uns ist alles möglich. Wir möchten Dich dabei unterstützen, die für Dich besten Arbeitszeiten zu wählen. - Du erstellst eigenständig und fristgerecht Krebsregistermeldungen nach ADT/ GEKID-Basisdatensatz an die jeweils zuständigen Landeskrebsregister unter Anwendung von onkologischen Klassifikationen und Dokumentationsstandards. - Du dokumentierst unstrukturierte onkologische Patientendaten aus klinischen Krankenhaus- und Arztpraxissystemen in unser eigens dafür entwickeltes Softwaresystem, einschließlich der komplexen Erfassung, Speicherung und Überprüfung von klinischen Diagnose-, Behandlungs- und Nachsorgedaten. - Du bringst Dein onkologisches Fachwissen ein und erweiterst dies kontinuierlich, um eine detailgetreue und vollständige Dokumentation in einer Vielzahl von klinischen Projekten zu ermöglichen. - Du gibst direktes Feedback zu neuen Funktionen, Tools und Workflows und trägst damit zur inhaltlichen Weiterentwicklung und Qualitätssicherung unserer Softwarelösungen bei. - Du unterstützt uns dabei, schriftliche Arbeitsanweisungen zur korrekten und einheitlichen Dokumentation stetig weiter zu entwickeln. - Du evaluierst Ansätze zur Dokumentation neuer Datenelemente. - Du bist aktiv in die Abläufe für Datenqualität eingebunden. Qualifications - Eine abgeschlossene Ausbildung als Medizinische:r Dokumentationsassistent:in, Medizinische:r Dokumentar:in oder Gesundheits- und Krankenpfleger:in. - Alternativ: Weiterbildung als Study Nurse, Clinical Research Associate (CRA), Clinical Trial Manager:in oder vergleichbare einschlägige Berufserfahrung. - Idealerweise Zertifikat “Tumordokumentar:in”. - Nachgewiesene Erfahrung in der medizinischen Tumordokumentation. - Fundierte Kenntnisse in der Erstellung von Krebsregistermeldungen (unter Berücksichtigung der Landes- und/oder Bundesvorgaben). - Kenntnisse im Umgang mit dem Gießener Tumordokumentationssystem (GTDS/Web-GTDS) oder vergleichbaren onkologischen Dokumentationslösungen sind erwünscht. - Sehr gutes medizinisches Fachwissen in onkologischen Krankheitsbildern. - Sichere Anwendung der medizinischen Nomenklatur und Klassifikation der Krankheiten nach ICD-O und ICD-10. - Basis-IT-Kenntnisse (idealerweise Mac OS) und Offenheit für neue Softwarelösungen. - Sicherer Umgang mit Google-Workspace-Anwendungen. - Ausgeprägte Stressresistenz und die Fähigkeit, auch unter Druck qualitativ hochwertige Arbeit zu leisten. - Hohe Zuverlässigkeit, Kommunikationsfähigkeit und Teamgeist. - Deutsch auf muttersprachlichem Niveau, Englisch Grundkenntnisse. Benefits - Bei Flatiron stehen unsere Mitarbeiter:innen bei allem, was wir tun, im Mittelpunkt. - Wir sind bestrebt, ein inklusives Arbeitsumfeld zu schaffen, das Zugehörigkeit stärkt. - Unsere Teams fühlen sich befähigt, mit Selbstvertrauen wertvolle Beiträge zu unserer Mission zu leisten.


