Medical Director – Medicaid

Job not on LinkedIn

🕒 August 5

🐊 Florida, Ohio, +2 more states – Remote

🐊 Florida – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote ⚔️ Virginia – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 3%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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 • Conduct peer-to-peer consultations with treating providers • Perform pharmacy reviews and first-level appeal determinations • Collaborate with multidisciplinary clinical and operational teams • Primarily support Aetna Better Health of Virginia • Provide support across Maryland, New Jersey, New York, Pennsylvania, and other health plans as needed • Participate in a rotating on-call schedule, including weekend and holiday coverage • Help ensure timely, consistent, and clinically sound decisions for members and providers

🎯 Requirements

• 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 • Active, unrestricted Virginia medical license • Ability to obtain and maintain medical licenses in Maryland, New Jersey, New York, and Pennsylvania • 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 • Post-graduate direct patient care experience

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting the physical, emotional, and financial well-being of colleagues and their families • Comprehensive benefits package for full-time colleagues and their families, based on eligibility