Medical Director - Kentucky Medicaid

CVS Health; Frankfort (KY); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading health solutions company seeks a Medical Director for Kentucky Medicaid. This role focuses on Utilization Management and supports the Aetna Better Health of Kentucky, primarily working from home. The ideal candidate will have extensive experience in healthcare delivery and a current medical license.

Benefits

Comprehensive benefits package

401(k)

Stock purchase plans

Wellness programs

Paid time off

Flexible schedules

Tuition assistance

Qualifications

• Five or more years of experience in Healthcare Delivery System.
• Active Kentucky medical license required.

Responsibilities

• Ensure timely responses to members and providers regarding precertification.
• Responsible for Utilization Management including prior authorization.

Skills

Healthcare Delivery System

Utilization Management

Clinical Practice

Education

M.D. or D.O.

Board Certification in ABMS or AOA

Job description

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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? Check out 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, West Virginia, and Oklahoma.

This role supports the Aetna Better Health of Kentucky primarily, and the Southeast Region (FL, LA, WV).

This Medical Director will be a "Work from Home" position primarily supporting the 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 requests.

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, peer-to-peer calls, and first-level appeals.

Minimum Qualifications

• Five or more years of experience in Healthcare Delivery System, e.g., Clinical Practice and Healthcare Industry.
• Active and current Kentucky medical license without encumbrances, with the ability to obtain licenses in 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 preferred.
• Prior Utilization Management experience working at a Health Plan/Insurer or as a Physician Advisor or with an Independent Review Organization is a plus.

Preferred Qualifications

• Health plan/payor Utilization Management/Review experience.
• Experience with electronic medical systems/records.
• Managed Care experience.
• Medicaid experience.

Pay Range
The typical pay range for this role is $174,070.00 - $374,920.00. This range reflects base salary or hourly wage, with actual offers depending on experience, education, and location. The role is eligible for bonuses, incentives, and equity awards.

Our people fuel our future. Our teams reflect the communities we serve, and we are committed to fostering a workplace where every colleague feels valued and included.

Benefits
We offer a comprehensive benefits package including medical, 401(k), stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, and more. For details, visit https://jobs.cvshealth.com/us/en/benefits.

Application deadline: 05/30/2025.

Qualified applicants with arrest or conviction records will be considered in accordance with laws.

Seniority level

• Director

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care