Medical Director - Kentucky Medicaid

CVS Health Corporation; California (MD); Remote; USD 174,000 - 375,000; Full time

Job summary

An established industry player is seeking a Medical Director to lead their Medicaid initiatives. This remote role offers a unique opportunity to influence health care delivery across multiple states. The ideal candidate will possess a strong background in clinical practice and utilization management, ensuring effective patient care and compliance with regulations. Join a dynamic team committed to transforming health care and making a difference in the lives of millions. With competitive pay and a comprehensive benefits package, this position is perfect for those looking to advance their career in a supportive environment.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Flexible work schedules

Tuition assistance

Qualifications

• Five or more years of experience in Health Care Delivery System.
• Active Kentucky state medical license and ability to obtain others.
• M.D. or D.O. with current Board Certification.

Responsibilities

• Ensure timely responses to members and providers regarding precertification.
• Responsible for Utilization Management and prior authorization.
• Focus on inpatient or outpatient cases and peer to peer calls.

Skills

Health Care Delivery System

Utilization Management

Clinical Practice

Patient Care

Peer to Peer Calls

Education

M.D. or D.O.

Board Certification

Post-graduate direct patient care experience

Tools

Electronic Medical Systems

Job description

Medical Director - Kentucky Medicaid

Medical Director - Kentucky Medicaid

Apply remote type Remote locations KY - Work from home Work At Home-Ohio Work At Home-Oklahoma Work At Home-Texas Work At Home-Georgia time type Full time posted on Posted 7 Days Ago time left to apply End Date: April 30, 2025 (19 days left to apply) job requisition id R0489083

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 Kentucky primarily, and the Southeast Region (FL, LA and WV).

This Medical Director will be a "Work from Home" position primarily supporting the Aetna Kentucky 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 Kentucky state medical license without encumbrances as well as the ability to obtain a Florida, Louisiana and West Virginia.
• 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.

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

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