Medical Director, Medical Affairs
Core
Provide clinical oversight, mentorship, and consultative support for CVS Health clinical programs, PBM quality activities, and P&T processes.
Role type
Senior IC Medical Director (Medical Affairs)
Builds
Clinical programs, utilization management criteria, and clinical policies for commercial, Medicare/Medicaid, and specialty pharmacy segments.
Domain
Health insurance / Pharmacy Benefit Management (PBM)
Required skills
Clinical judgment, evidence-based guidelines synthesis, utilization management, medical necessity appeals, inter-rater review, regulatory knowledge, statistical analysis
Preferred skills
Managed care environment experience, health administration, UM/QA certification, MS Office proficiency
Technologies
MS Office Suite
Responsibilities
Review clinical cases and coverage requests for specialty medications, oncology therapies, biologics, and newly marketed drugs; conduct utilization reviews and medical necessity appeals for commercial and governmental clients; participate in inter-rater review activities; oversee clinical programs and policy revisions; perform special clinical investigations and research projects.
Seniority
Director, hands-on IC with management responsibilities