Medical Director - Medicaid (Oklahoma)

Hispanic Alliance for Career Enhancement; Remote; EUR 148.000 - 320.000; Vollzeit

Zusammenfassung

A prominent health solutions company is seeking a Medical Director for Utilization Management, primarily a remote position supporting the Aetna Oklahoma Medicaid plan. The role requires an M.D. or D.O. with extensive direct patient care experience and appropriate certifications. Responsibilities include managing precertification and concurrent review processes, and responding to member and provider inquiries. Great benefits include medical plans, 401(k), and wellness programs. Applications close on 01/30/2026.

Leistungen

401(k) plan with company matching

Employee stock purchase plan

Tuition assistance

Wellness programs

Qualifikationen

• Five or more years of experience providing direct patient care.
• Oklahoma state medical license without encumbrances.
• Current and Active Board Certification in ABMS or AOA recognized specialty.

Aufgaben

• Ensure timely responses to members and providers.
• Responsible for Utilization Management, including prior authorization.
• Part of a rotating on-call schedule for weekend and holiday coverage.

Kenntnisse

Direct patient care

Utilization Management

Managed Care

Medicaid experience

Ausbildung

M.D. or D.O.

Jobbeschreibung

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states: Arizona, California, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and West Virginia. This is a regional role that primarily supports the Aetna Better Health Plan of Oklahoma.

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.

The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. This position is 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. You will be part of a rotating on‑call schedule for providing weekend and holiday coverage.

Required Qualifications

• 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 +.

Preferred Qualifications

• Preferred Oklahoma residency.
• Health plan/payor Utilization Management / Review experience.
• Managed Care experience.
• Medicaid experience.

Education

M.D. or D.O.

Pay Range

Typical pay range: $174,070.00 – $374,920.00. This represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Benefits

Great benefits for great people

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 01/30/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.