Medical Director, Medical Affairs

CVS Health•Work At Home-Illinois, IL

1d•$174,070 - $374,920•Remote

About The Position

CVS Health’s Medical Affairs department provides clinical business support across the enterprise, including clinical oversight and mentorship for clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services, pipeline activities, and clinical leadership for internal departments and clients. Medical Directors model clinical integrity, knowledge, cross-functional thinking, and sound decision-making. They represent prescriber clinical judgment as a partner in enterprise decisions and planning. The role reviews clinical cases and coverage requests across areas such as specialty medications, oncology therapies, biologics, and newly marketed drugs, applying current medical literature and evidence-based guidelines to make objective, clinically appropriate, consistent, and well-supported determinations. The Medical Director reports to a Senior Medical Director in Medical Affairs and provides clinical support and consultative services across the PBM. The role may also support Account Management for assigned key clients. Much of the work involves assigned medication utilization reviews and medical necessity appeals for commercial, Medicare, Medicaid, and other client programs. Peer-to-peer conversations may sometimes be required. Directors assigned to one business segment may also support other segments during evening and weekend coverage. The role participates in inter-rater review and other quality oversight processes, may oversee portions of CVS Health clinical programs and commercial client support, and may contribute to utilization management criteria and clinical policy reviews or revisions. Special clinical investigations and research may also be assigned, ranging from brief literature reviews to more in-depth projects involving collaboration with pharmacists in Medical Affairs and other business units. This is a full-time, remote, work-from-home opportunity. The role is eligible for a CVS Health bonus, commission or short-term incentive program, and an award target in the company’s equity award program. The stated base pay range is $174,070 to $374,920; actual offers depend on factors including experience, education, and geography.

Requirements

Family Medicine or Internal Medicine board certification is required.
At least 5 years of clinical experience in direct patient care.
At least 2 years of 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 where the candidate is located.
Graduate of an accredited medical school and residency program.
Maintain current annual Continuing Medical Education (CME) and remain current in medical and management areas during employment.

Nice To Haves

Additional subspecialty board certification is strongly preferred.
Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate direct patient care experience and experience working with professionals at different levels as teammates.
ABMS or AOA board certification in Internal Medicine or Family Medicine.
Master’s degree in Public Health Administration or MBA.
UM/QA certification.
Proficiency in MS Office Suite.

Responsibilities

Review clinical cases and coverage requests, including requests involving specialty medications, oncology therapies, biologics, and newly marketed drugs.
Evaluate medical literature and evidence-based guidelines and make objective, clinically appropriate, consistent, and evidence-based coverage determinations.
Provide clinical support and consultative activities across the PBM, potentially including support to Account Management for assigned key clients.
Complete assigned medication utilization reviews and medical necessity appeals for commercial, Medicare, Medicaid, and other client programs.
Conduct peer-to-peer conversations when required.
Support other business segments, including commercial and Medicaid, during evening and weekend coverage when needed.
Participate in inter-rater review activities and other quality oversight processes for internal utilization management decisions.
Provide oversight for portions of CVS Health clinical programs and commercial client program support as assigned.
Participate in reviews and revisions of utilization management criteria and clinical policies.
Conduct special clinical investigations and research, including literature reviews and collaborative projects with pharmacists and other business units.