Medical Director (ABH-WV)

Hispanic Alliance for Career Enhancement; Charleston (WV); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading health solutions company seeks a Medical Director to oversee Utilization Management for Aetna's West Virginia plan. This remote position requires extensive experience in health care delivery and a current medical license. The role involves ensuring timely responses to member and provider requests and managing authorization processes.

Benefits

Affordable medical plan options

401(k) plan with company matching

Employee stock purchase plan

No-cost wellness programs

Flexible work schedules

Tuition assistance

Qualifications

• Five or more years of experience in Health Care Delivery System.
• Active West Virginia state medical license.
• M.D. or D.O. with Board Certification.

Responsibilities

• Ensure timely responses to precertification and review requests.
• Responsible for Utilization Management including prior authorization.
• Support Medical Management staff.

Skills

Health Care Delivery System

Utilization Management

Clinical Practice

Education

M.D. or D.O.

Board Certification in ABMS or AOA recognized specialty

Job description

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, Pennsylvania, Texas, Virginia and West Virginia and Oklahoma.
This role supports the Aetna Better Health of West Virginia primarily, and the Southeast Region (FL, KY and LA).
This Medical Director will be a "Work from Home" position primarily supporting the Aetna West Virginia plan; but part of a centralized team that supports the Medical Management staff.
The 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 and pre certification as well as concurrent review. Cases could focus on inpatient or outpatient, acute and post-acute as well as peer to peer calls and first level appeals.

Required Qualifications:
- Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and current West Virginia state medical license without encumbrances as well as the ability to obtain a Florida, Louisiana and Kentucky.
- M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty; including post-graduate direct patient care experience
- Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred.
- 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:
-Health plan/payor Utilization Management / Review experience.
-Electronic medical systems/record experience.
-Managed Care experience.
-Medicaid experience.

Education

-M.D. or D.O., Board Certification in ABMS or AOA recognized specialty including post-graduate direct patient care experience.

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,920.00

This pay range 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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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: 06/20/2025

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