Medicaid Medical Director (Remote) — Utilization & Quality

CVS Health; United States; Remote; USD 174,000 - 375,000; Full time

Benefits offered by this job

Comprehensive benefits package

Paid time off and retirement options

Job summary

CVS Health is seeking a Medical Director to lead medical management for Medicaid populations with a national scope, primarily supporting Aetna Better Health of Louisiana. In this remote role, you will oversee utilization management, prior authorizations, and peer-to-peer consultations, guiding clinical decisions and collaborating with multidisciplinary teams to improve quality and outcomes.

The position requires MD or DO with ABMS/AOA board certification, an active medical license, and 5+ years

Qualifications

• MD or DO with current, active Board Certification in an ABMS- or AOA-recognized specialty.
• Active, unrestricted medical license with ability to license in Florida and Kentucky.
• 5+ years of post-residency clinical practice and direct patient care experience.

Responsibilities

• Utilization Management and medical necessity reviews
• Prior authorization and precertification determinations
• Concurrent review for inpatient and outpatient services
• Acute and post-acute care reviews
• Peer-to-peer consultations with treating providers
• Pharmacy reviews and first-level appeal determinations
• Collaboration with multidisciplinary clinical and operational teams

Skills

Active medical license

Board certification

5+ years clinical practice

Utilization management experience

Electronic Health Records

Education

MD or DO

ABMS/AOA board certification

Tools

Electronic Health Records (EHR)

Job description

CVS Health is seeking a Medical Director to lead medical management for Medicaid populations with a national scope, primarily supporting Aetna Better Health of Louisiana. In this remote role, you will oversee utilization management, prior authorizations, and peer-to-peer consultations, guiding clinical decisions and collaborating with multidisciplinary teams to improve quality and outcomes.

The position requires MD or DO with ABMS/AOA board certification, an active medical license, and 5+ years