CVS Health
Medical Director (Medical Policy & Operations)
$174K–$375K
CT - Work from home · Remote · Director · Full-time · Posted Oct 19, 2026
- Experience
- At least one year employed within a health insurance company; five or more years in a health care delivery system and health care industry.
- Education
- MD or DO; ABMS-recognized board certification and postgraduate direct patient care experience.
About the job
Provides clinical expertise on medical and payment policy, including reviews of appeals, claims, and benefit predeterminations in Commercial and Medicare settings.
What you'll do
- Conduct transactional reviews supporting appeals, clinical claim review, and predetermination of covered benefits.
- Apply clinical coding and reimbursement expertise to ensure correct application of policies to service and payment requests.
- Contribute clinical expertise to policy work groups and use data analysis to identify quality improvement opportunities.
What they ask for
- At least one year employed within a health insurance company.
- Five or more years of experience in a health care delivery system and health care industry.
- Active, current state medical license without encumbrances.
- M.D. or D.O., ABMS-recognized board certification, and postgraduate direct patient care experience.
Nice to have
- Health plan/payor experience.
- Foundational skills in medicine, health policy, coding, clinical policy, reimbursement, and health care systems.
Pay
$174,070.00 - $374,920.00 (USD, base salary)
Tools
HCPCS, CPT
Model-written summary · the original posting is authoritative