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Medical Director - Medicaid

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States

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Category:
-

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Contract Type:
Not provided

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Salary:

174070.00 - 374920.00 USD / Year
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Job Description:

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. This UM (Utilization Management) Medical Director will be a "Work from Home" position primarily supporting the Aetna Oklahoma Medicaid plan and the UM team; but part of a centralized team that supports Illinois, Michigan and Oklahoma. Support for other regions may occasionally be required.

Job Responsibility:

  • Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request
  • Primarily responsible for Utilization Management, including prior authorization as well as concurrent review
  • Cases could focus on inpatient or outpatient services, acute and post acute services, pharmacy, appeals and state fair hearings
  • Part of a rotating on call schedule for providing weekend and holiday coverage

Requirements:

  • Five or more years of experience providing direct patient care
  • Oklahoma state medical license without encumbrances
  • M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty
  • including post-graduate direct patient care experience
  • Board certification in Family Medicine, General Surgery or Internal Medicine / Pediatrics
  • Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus +

Nice to have:

  • Preferred Oklahoma residency
  • Health plan/payor Utilization Management / Review experience
  • Managed Care experience
  • Medicaid experience
What we offer:
  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs for all colleagues including 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:
February 25, 2026

Expiration:
February 27, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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