Medical Director-Medicaid, CVS Health

Medical Director-Medicaid

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 supporting Aetna Better Health of Florida and the Southeast Region (KY, LA and WV). Part of a centralized team that supports Medical Management staff, ensuring timely responses to members and providers for precertification, concurrent review, and appeals.

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 precertification as well as concurrent review
Review cases focusing on inpatient or outpatient, acute and post-acute care
Participate in peer to peer calls and first level appeals
Participate in rotating on call schedule to provide weekend and holiday coverage

Requirements:

Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry
Active and current Florida state medical license without encumbrances as well as the ability to obtain Kentucky, Louisiana and West Virginia licenses
M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty, including post-graduate direct patient care experience
Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred

Nice to have:

Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization
Electronic medical systems/record experience
Managed Care experience
Medicaid experience

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling
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:
August 27, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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