Medical Director - MPO (Medical Policy & Operations)

Position Summary 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 prioritise 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. Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company? This is a remote Work at Home position and can be located anywhere in the United States. Responsibilities In this role as Medical Director MPO (Medical Policy & Operations) you will provide clinical expertise to promote the delivery of high quality, constituent‑focused medical care with a focus on clinical and payment policy. Conduct transactional reviews in support of the appeal process, clinical claim review process, and predetermination of covered benefits in the Medicare and commercial environments; with emphasis on Medicare clinical and payment policy. Participate on work groups as a clinical subject‑matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. Apply clinical, coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests. Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services. Act as a subject‑matter expert, internal consultant and payment policy contributor. Demonstrate the ability to work within and lead, as necessary, teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. Collaborate with the functional areas. Qualifications Required Five (5) or more years of experience in the Health Care Delivery System (e.g., clinical practice and health care industry). Active and current state medical license without encumbrances. M.D. or D.O., board certification in an ABMS‑recognized specialty including post‑graduate direct patient care experience. Preferred Health plan/payor experience. Experience with NCDs, LCDs, and Medicare reviews. Foundational baseline skills in medicine, health policy, coding (HCPCS / CPT), clinical policy, reimbursement and health care systems. Strong communication skills, both written and verbal. Education M.D. or D.O., board certification in an ABMS‑recognized specialty including post‑graduate direct patient care experience. Pay Range The typical pay range for this role is $174,070.00 – $374,920.00. This represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above and includes an award target in the company’s equity award program. Benefits 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. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs and other resources, based on eligibility. We anticipate the application window for this opening will close on: 06/12/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr