Medical Director - Pain Management

In This Role You Will

• Provide clinical leadership and expertise to Medical Management staff, ensuring timely, consistent, and evidence-based responses to members and providers.
• Lead utilization management and quality assurance activities, including oversight of medical necessity reviews and case management initiatives.
• Support medical management programs through active participation in interdisciplinary clinical team activities and strategic decision-making.
• Serve as the primary clinical and business liaison to network providers and healthcare facilities, fostering collaboration and supporting the effective implementation of medical services programs.
• Conduct predetermination reviews and claim determination reviews, applying clinical judgment and expertise in medical coding, reimbursement, and coverage policies.
• Provide guidance and consultation on complex clinical cases, helping ensure quality outcomes and regulatory compliance.
• Support the development and continuous improvement of medical management strategies, policies, and processes.
• Post-graduate direct patient care experience in pain management.
• Demonstrated expertise in utilization management, case management, quality improvement, and clinical review processes.
• Strong knowledge of medical coding, reimbursement methodologies, and healthcare regulations.
• Excellent communication, collaboration, and leadership skills with the ability to engage effectively with providers, clinical teams, and business stakeholders.
• Required Qualifications * 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. * Active and current state medical license without encumbrances * M.D. or D.O., Board Certification in Pain Management specialty including post-graduate direct patient care experience specifically Preferred Qualifications * Previous healthcare insurance experience.
• Education * M.D. or D.O., Board Certification in a Pain Management specialty.
• 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.
• 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 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: 08/21/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.