Medical Director Jobs

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: Ready to take your Medical Director career to the next level with a Fortune 6 company? Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country. Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia. We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Louisiana , while also providing support across the other health plans as needed. In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include: Utilization Management and medical necessity reviews Prior authorization and precertification determinations Concurrent review for inpatient and outpatient services Acute and post-acute care reviews Peer-to-peer consultations with treating providers Pharmacy reviews and first-level appeal determinations Collaboration with multidisciplinary clinical and operational teams The Medical Director also participates in a rotating on-c

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

Medical Director - Commercial — 41 Locations. Apply via Workday.

Medical Director, Medical Affairs — . Apply via Workday.

Medical Director (Medical Policy Ops-DRG) — CT - Work from home. Apply via Workday.

Medical Director - ENT — 51 Locations. Apply via Workday.

Medical Director - Medicaid Appeals — 26 Locations. Apply via Workday.

Medical Director MPO — 31 Locations. Apply via Workday.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Purpose and Summary: Join a mission-driven organization at a transformative moment in employer-sponsored health care. As Executive Medical Director, Clinical Business Solutions at Aetna, a CVS Health company, you will lead the clinical team that serves as the clinical voice to our Commercial plan sponsors, prospects, and their advisors, demonstrating how Aetna’s clinical capabilities reduce cost, improve population health, and strengthen the member and provider experience. Reporting directly to the Vice President, Chief Medical Officer, Commercial & Innovation, you will direct a national team of clinicians (MD, RN, NP) providing clinical support to Aetna’s National Accounts, Large Group, and Public & Labor businesses, in close partnership with Field and Account teams. You will lead and continuously improve the operations of the team to raise the level and quality of clinical support delivered to the Field, while sharing directly in its external work — including personally cultivating and holding relationships with key brokers, consultants, and plan sponsors. The role is deliberately bidirectional. You will bring the voice of the customer and the producer community back into the organization, partnering with Clinical Operations, Medical Affairs, Commercial Product, and others to ensure our clinical offerings reflect what the market requires. <p

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Senior Medical Director, Clinical Informatics Position Summary The Senior Medical Director for Clinical Informatics and Healthcare Delivery (HCD) Technology Product serves as the senior physician leader across healthcare delivery technical domains, providing clinical insight and technical expertise to drive end-to-end technology execution and ensure that Epic-enabled solutions advance core business outcomes. This role is the clinical expert and trusted physician advisor for teams across HCD technology, driving effective enterprise governance, improving clinician experience, enhancing patient outcomes, and supporting organizational strategic priorities. The Senior Medical Director will also serve as the product leader for two core HCD technology domains - Center Operations and Quality/Stars. The Senior Medical Director brings hands-on clinical and Epic build expertise, partners closely with operational and technical leadership across the enterprise to align the Epic roadmap with organizational strategy, has excellent clinical judgement and keeps patient experience, safety, and outcomes at the center of everything we do, and represents the clinical voice in enterprise governance, escalation, and innovation efforts. Key Responsibilities Clinical Product & Technology Leadership Serve as the senior product leader across Clinic Operations and Quality

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The purpose of the Center Medical Director role is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients happy, healthy and out of the hospital. The Medical Director will practice primary care in our clinics alongside their provider colleagues at 80% clinical time and 20% administrative time. The CMD will have mission-critical leadership responsibilities, which include setting an example for how thoughtful primary care is practiced, serving as a formal mentor, coach, and advisor to providers in clinics, and participating in critical organizational-wide strategic initiatives. Core Responsibilities: The Center Medical Director is the medical leader for his/her center. In this role the CMD will have the following responsibilities: Support of Organizational Strategy Work in tight collaboration with the Practice Manager and Outreach Manager/Director to achieve our organizational objectives: Best Care Anywhere Unmatched Patient Experience Exceptional Growth Great Place to Work and Leader in DE&I Drive implementation of strategic initiatives. Follow direction from regional leadership (regional medical director or senior medical director) in collaboration with CMDs in the region to implement regional priorities and reach regional objectives.<br

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Title: Center Medical Director Company: Oak Street Health Role Description: The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients happy, healthy and out of the hospital. The Medical Director will practice primary care in our clinics alongside their provider colleagues at 80% clinical time and 20% administrative time. The CMD will have mission-critical leadership responsibilities, which include setting an example for how thoughtful primary care is practiced, serving as a formal mentor, coach, and advisor to providers in Oak Street clinics, and participating in critical organizational-wide strategic initiatives. Core Responsibilities: The Center Medical Director is the medical leader for his/her OSH center. In this role the CMD will have the following responsibilities: Support of Organizational Strategy Work in tight collaboration with the Practice Manager and Outreach Manager/Director to achieve our organizational objectives: Best Care Anywhere Unmatched Patient Experience Exceptional Growth Great Place to Work and Leader in DE&I Drive implementation of OSH strategic initiatives. Follow direction

Center Medical Director — CT - New Britain. Apply via Workday.

ROLE SUMMARY The Clinician Medical Monitor is accountable for providing medical and scientific expertise and oversight for Clinical Trials and serves as a single point of accountability for design, execution, monitoring, delivery and reporting of one or more clinical studies and to ensure patient safety. The clinician medical monitor may be required to design a development strategy for multiple protocols designed to obtain worldwide approval for a compound or group of compounds. In addition to study level activities, the clinician medical monitor may participate in standing committees, review compounds for potential in-licensing, including performance of due diligence reviews, and aid new business development on market opportunities and the target product profile. ROLE RESPONSIBILITIES Accountable for safety across the study Provide study team with medical advice for all medical issues during risk assessment and mitigation planning to enable quality, compliance and patient safety at the trial, site and patient level. Ensures development of and adherence to the Safety Surveillance Review Plan (SSRP). Consistent with the SSRP, performs and documents regular review of individual subject safety data, and performs review of cumulative safety data with the safety risk lead. As appropriate, the clinician medical monitor may delegate these responsibilities to the study clinician scientist identified in the SSRP. The specific components of safety data review are detailed in the appropriate SOPs and the “Safety Data Review Guide – for Clinicians.” Monitor study safety issues and provide input to serious adverse events (SAEs) reports. Provides appropriate medical context in terms of risk factors, medical history and other important medical factors required to put the SAE or AE into appropriate medical context required for benefit-risk assessm

Oncology Field Medical Director, Hematology (MD) — 3 Locations. Apply via Workday.