Medical Director, Medical Affairs
Core
Provide clinical oversight, mentorship, and consultative support for CVS Health's clinical programs, PBM quality activities, and formulary development.
Role type
Senior IC Medical Director (Medical Affairs)
Builds
Clinical policies, utilization management criteria, and evidence-based coverage determinations for commercial, Medicare/Medicaid, and specialty pharmacy programs.
Domain
Health Insurance / Pharmacy Benefit Management (PBM)
Required skills
Clinical judgment, evidence-based medicine, medical literature synthesis, utilization management, regulatory compliance, inter-rater review, special clinical investigations
Preferred skills
Managed care environment experience, health administration, public health administration, MBA, UM/QA certification
Technologies
MS Office Suite
Responsibilities
Review clinical cases and coverage requests for specialty medications, oncology therapies, biologics, and newly marketed drugs; conduct medication utilization reviews and medical necessity appeals; participate in inter-rater review activities; oversee clinical programs and policy revisions; perform special clinical investigations and research.
Seniority
Senior, hands-on IC
