Medical Director – Medicaid

Job not on LinkedIn

🔥 14 hours ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

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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

• Support Aetna Better Health of Louisiana and other health plans as needed through centralized Medical Management • Partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers • Conduct utilization management and medical necessity reviews • Make prior authorization and precertification determinations • Perform concurrent reviews for inpatient and outpatient services • Conduct acute and post-acute care reviews • Participate in peer-to-peer consultations with treating providers • Conduct 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

🎯 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 • 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 preferred

🏖️ 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