Medical Director (Aetna One Advocate)

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. *** Fully remote position; PT preferred). *** Aetna One Advocate (A1A) is a high-touch, population health medical management team built around collaboration, advocacy, and case-by-case resolution for our members. We're a tight-knit team of clinicians who use a multidisciplinary model to guide members toward their best possible health care outcomes. As a Medical Director on this team of 8 physicians, you'll help shape how that model is executed clinically and operationally, while being part of a close collaborative culture. You'll provide clinical oversight for medical policy implementation and lead utilization management activities. Including predetermination reviews, Utilization management determinations and case management. Participate in the development, implementation, and evaluation of clinical/medical programs Help expand Aetna's medical management programs to better address member needs across the continuum of care Support Medical Management staff in delivering timely, consistent responses to members and providers Oversee utilization review and quality assurance activities Provide clinical expertise and business direction for medical management programs through active participation in clinical team activities Serve as lead clinical and business liaison to network providers and facilities, supporting effective execution of medical services programs Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings (approx. Board certification/eligibility in Neurosurgery, Orthopedic Surgery, General Surgery, or Physical Medicine & Rehabilitation (PM&R) strongly preferred No prior utilization management or managed care experience required — full training provided Fully remote position; PT preferred). Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience 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. 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. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 11/15/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.