Medical Director - Medicaid Northeast, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

Medical Director role supporting Aetna's Medicaid plans in the Northeast region, focusing on Utilization Management including prior authorization and concurrent review. This is a work from home position primarily supporting the Aetna Northeast Medicaid plan and the UM team.

Job Responsibility:

Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request
Utilization Management including prior authorization and concurrent review
Review cases focusing on inpatient or outpatient services, acute and post-acute services, pharmacy, appeals and state fair hearings
Part of rotating on call schedule for providing weekend and holiday coverage

Requirements:

Five or more years of experience providing direct patient care
Active state medical license without encumbrances and the willingness to get licensure in other states as needed
M.D. or D.O.
Current and Active Board Certification in ABMS or AOA recognized specialty, including post-graduate direct patient care experience

Nice to have:

Board certification in Physical Medicine & Rehabilitation, Emergency Medicine, Family Medicine (with hospitalist experience) or Internal Medicine
Physician leadership

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 24, 2025

Expiration:
September 26, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director - Medicaid Northeast