Medical Director-Medicaid (ABH VA)

9025 CVS Shared Services Resources LLC; Virginia; Hybride; USD 174 000 - 375 000; Plein temps

Avantages offerts par ce poste

Health benefits

Bonus program

Equity awards

Résumé du poste

CVS Health is seeking a Medical Director to join its centralized Medical Management team. This fully remote role supports Medicaid members nationwide and requires an active Virginia medical license.

The position collaborates with multidisciplinary teams and participates in rotating on-call coverage. Strong clinical leadership, utilization management experience, and knowledge of prior authorizations, reviews, and appeals are essential.

Qualifications

• MD or DO with current, active board certification in an ABMS- or AOA-recognized specialty.
• 5+ years of post-residency clinical practice and direct patient care experience.
• Active, unrestricted Virginia medical license.
• Ability to obtain and maintain medical licenses in Maryland, New Jersey, New York and Pennsylvania.

Responsabilités

• Utilization Management and medical necessity reviews.

Connaissances

Clinical experience

Medical decision making

Peer-to-peer

Utilization management

Licensing coordination

Formation

MD/DO with ABMS/AOA board certification

Description du poste

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

This is a full‑time, fully remote role. You can work from anywhere in the United States. Must hold an active, unrestricted Virginia medical license. Join Aetna, a CVS Health company, and make a meaningful impact on the health and well‑being of Medicaid members across the country. Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and WestVirginia. We are seeking a Medical Director to join our centralized Medical Management team. This work‑from‑home position will primarily support Aetna Better Health of Virginia, while also providing support across the Northeast Region (Maryland, NewJersey, NewYork, and Pennsylvania) and other health plans as needed. In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers.

Key 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
• The Medical Director also participates in a rotating on‑call schedule that includes weekend and holiday coverage.

Required Qualifications

• M.D. or D.O. degree with current, active Board Certification in an ABMS- or AOA‑recognized specialty.
• 5+ years of post‑residency clinical practice and direct patient care experience.
• Active, unrestricted Virginia medical license.
• Ability to obtain and maintain medical licenses in Maryland, NewJersey, NewYork and Pennsylvania.

Preferred Qualifications

• Board certification in Family Medicine, Emergency Medicine, or Internal Medicine‑Pediatrics.
• Prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor capacity.
• Medicaid and managed care experience.
• Experience with medical necessity review, prior authorization, concurrent review, appeals, and peer‑to‑peer consultation.
• Experience using electronic health records and other clinical documentation systems.

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.

Benefits

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

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

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self‑disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

We anticipate the application window for this opening will close on: 11/14/2026