CVS Pharmacy, Inc.Hiring

Medical Director (Medical Policy & Operations)

  • USD 174,070 to 374,920 per year
  • Remote, United States
  • Full-time
  • Lead
  • Posted 2 weeks ago
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In one line

Remote medical director role at a national insurer, reviewing appeals, claims and benefit requests and advising on clinical and payment policy.

About the role

Clinical judgement applied to coverage decisions in commercial and Medicare plans, plus policy input for payment and care quality. An MD or DO with an active licence and board certification is required.

At a glance

Pay
USD 174,070 to 374,920 per year
Remote scope
Remote, United States
Seniority
Lead
Employment
Full-time
Skills
HCPCS, CPT, Clinical Policy, Reimbursement, Health Care Systems
Posted
20 Oct 2026
Last checked
1 Nov 2026

What you will do

  • Review appeals and clinical claims and decide on covered benefits
  • Apply coding and reimbursement rules correctly to payment requests
  • Advise work groups as a clinical subject matter expert
  • Use data analysis to spot and push quality improvements
  • Act as an internal consultant on payment policy

What they look for

  • MD or DO with board certification in an ABMS specialty
  • At least five years in clinical practice or the health care industry
  • One year or more employed at a health insurance company
  • Active state medical licence with no restrictions
  • Post-graduate direct patient care experience

Nice to have

  • Health plan or payor experience
  • Familiarity with HCPCS and CPT coding and clinical policy

Benefits

  • Eligible for a bonus or short-term incentive program

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Questions about this job

Is this a remote job, and where can I work from?

Yes. The posting lists Medical Director (Medical Policy & Operations) as a remote role for candidates in the United States.

What does this job pay?

The posting states USD 174,070 to 374,920 per year.

What experience is needed?

It is a lead role. The posting asks for: MD or DO with board certification in an ABMS specialty; at least five years in clinical practice or the health care industry; one year or more employed at a health insurance company. Skills it names include HCPCS, CPT, Clinical Policy, Reimbursement.

How do I apply with Keywordise AI?

Click Apply with Keywordise AI, create an account and upload your CV. Your CV and cover letter are written for this job from what you have really done, then Keywordise applies for you. Trial: 7 days, no card.

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CVS Pharmacy, Inc.Remote, United States
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