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. Position Summary 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. We pride ourselves on being innovative and nimble , adapting our approach to what each member actually needs rather than applying one-size-fits-all solutions. 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. This role also blends clinical leadership with external engagement: you'll spend roughly 15% of your time presenting to and meeting with our plan sponsors. What You'll Do Lead utilization management, including predetermination and UM reviews Apply clinical expertise to support accurate, consistent decisions 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 activitiesDirect case management efforts 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. 15% of time) What we're looking for Active, unrestricted MD required 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 Comfort and experience presenting to external audiences - strong public speaking and stakeholder communication skills Collaborative mindset and comfort working in a close, fast-moving clinical team 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 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. 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. This position also includes an award target in the company's equity award program. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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: 10/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health