Executive Medical Director, Commercial
$227,630–$490,280 year
Remote · Connecticut, United States
Job Summary
Executive Medical Director, Commercial at CVS Health/Aetna Medical Affairs leads medical management programs and policies for plan sponsor clients nationwide. Responsible for clinical leadership of medical management activities, directing utilization review, ensuring compliance with clinical goals, overseeing medical policies and guidelines, and coordinating with plan sponsors, sales and renewal activities, and cross-functional teams. Leads senior medical directors and medical directors, contributes to affordability initiatives for the Commercial line, and provides clinical support for complex cases. Requires MD or DO with active board certification, state medical license, 5+ years of clinical and 5+ years administrative healthcare experience, data-driven decision making, and ability to travel ~10% with occasional weekend on-call coverage.
Required Qualifications
- MD or DO with active board certification in ABMS or AOA recognized specialty
- Current and Active State Medical License without encumbrances
- Five (5) or more years of experience in clinical practice
- Five (5) or more years administrative experience in the health care industry or managed care
- Demonstrated experience with utilization management, care management, and applicable state and federal regulations
- Experience leading and developing physician leaders and multidisciplinary clinical teams
- Ability to use data and analytics to inform clinical and business decisions
- Proven ability to drive process improvement and change in a complex, matrixed organization
- Effective communication skills with executives, providers, and clients
- Ability to manage multiple priorities in a fast-paced environment
- Strategic thinking and planning aligned with business objectives
- Ability to work in a virtual environment with ~10% travel
- Prior Commercial market experience in UM/CM (preferred)
- Experience with MCG and other clinical guidelines (preferred)
- Experience with plan sponsor or provider/client relations (preferred)
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