Medical Director, CVS Health

Medical Director

CVS Health

Location:
United States, Work At Home, Illinois

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

This UM (Utilization Management) Medical Director position primarily supports the Aetna Better Health Plan of Illinois and the UM team, ensuring the delivery of high-quality care to Medicaid members through utilization management and review processes.

Job Responsibility:

Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request
Responsible for Utilization Management, including prior authorization as well as concurrent review
Focus on inpatient or outpatient services, acute and post-acute services, pharmacy, appeals and state fair hearings
Participate in a rotating on-call schedule for weekend and holiday coverage

Requirements:

Five or more years of experience providing direct patient care
Illinois 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 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 Illinois 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 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:
June 06, 2025

Expiration:
June 20, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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