Exec Dir, Regional MD

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.Fundamental Components:The Executive Medical Director provides clinical and operational leadership across Aetna and CVS enterprise initiatives focused on documentation accuracy, compliance, and medical management performance. The role partners across business units to improve clinical outcomes, support risk analysis activities, lead audit-related work, and strengthen key external relationships. This leader also oversees medical management programs and policies, leads the territory Senior Medical Directors, and drives execution against strategic and operational priorities.Responsibilities include but can change as business needs dictate:Leads, develops, and directs clinical and non-clinical activities that improve health care quality, cost, and outcomesDirects the utilization review process and oversees the quality of utilization determinationsEnsures compliance with clinical goals by monitoring care management performanceOversees unit medical policies to support appropriate, cost-effective care and day-to-day management of medical management staffRecommends changes to managed care programs, review guidelines, and clinical criteria based on deep knowledge of care delivery, utilization, reimbursement, and treatment protocolsDevelops, implements, and interprets medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessmentsLeads clinical staff (territory senior medical directors and transactional medical directors) in coordinating quality care and provides clinical expertise and business direction to support medical management programsServes as the lead business and clinical liaison to network providers and facilities to support effective execution of medical services programsExpands Aetna medical management programs to address member needs across the continuum of careReviews and handles cases as neededProvides weekend on-call coverage as neededTravel potential 15–25%Required Qualifications3+ years of leadership experience in the Medicare line of business, or a related role3+ years of clinical practice experience3+ years of leadership experience in managed careM.D. or D.O. with board certification in a recognized specialty and post-graduate direct patient care experienceActive, unrestricted state medical licensePreferred QualificationsDemonstrated leadership experience in clinical operations, medical management, and utilization managementEducationMD or DOPay RangeThe typical pay range for this role is:$227,630.00 - $490,280.00This 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.  Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe 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: 06/26/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.