Medical Director – Medicaid

Job not on LinkedIn

🔥 2 hours ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Support Aetna Better Health of Louisiana and other health plans as needed • Perform Utilization Management and medical necessity reviews • Make prior authorization and precertification determinations • Conduct concurrent reviews for inpatient and outpatient services • Conduct acute and post-acute care reviews • Participate in peer-to-peer consultations with treating providers • Perform pharmacy reviews and first-level appeal determinations • Collaborate with multidisciplinary clinical and operational teams • Participate in a rotating on-call schedule including weekend and holiday coverage • Help improve quality, access, and outcomes for Medicaid populations

🎯 Requirements

• Must have an active, unrestricted medical license • Ability to be licensed in Florida and Kentucky • M.D. or D.O. degree • Current, active Board Certification in an ABMS- or AOA-recognized specialty • 5+ years of post-residency clinical practice and direct patient care experience • Preferred: active, unrestricted Louisiana medical license • Preferred: Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics • Preferred: prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor capacity • Preferred: Medicaid and managed care experience • Preferred: experience with medical necessity review, prior authorization, concurrent review, appeals, and peer-to-peer consultation • Preferred: experience using electronic health records and other clinical documentation systems

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program • Equity award program

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