Medical Director Aetna Duals Center of Excellence, CVS Health

Medical Director Aetna Duals Center of Excellence

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 position for the Aetna Duals Center of Excellence supporting Duals Integrated Plans in Ohio, Illinois, Michigan, Virginia, Pennsylvania, and New Jersey. The role involves supporting Medical Management staff ensuring timely responses to members and providers for precertification, concurrent review, and appeal requests.

Job Responsibility:

Utilization management – perform concurrent and prior authorization reviews with peer to peer coverage of denials
Appeals – perform appeals in their base plan and in the round robin based on same or similar specialty needs
Pharmacy coverage – perform pharmacy reviews
Participate in and be able to lead daily rounds

Requirements:

Minimum 3-5 years of clinical practice experience
Two (2) + years of experience in managed care (Medicare and/or Medicaid)
MD or DO
Board certification in an ABMS or AOA recognized specialty is required
Active and current state medical license without encumbrances is required
Multiple state licensure a plus

Nice to have:

Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System
Licensed in or willing to obtain license in at least one state where we have an Integrated plan
Experience with managed care (Medicare and Medicaid) utilization review preferred

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 23, 2025

Expiration:
October 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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