Medical Director - Medicaid (IL)

CVS Health; Springfield (IL); On-site; USD 174,000 - 375,000; Full time

Job summary

Join a leading health solutions company as a Medical Director - Medicaid in Illinois. This role involves overseeing Utilization Management for the Aetna Better Health Plan, ensuring quality care and compliance. Ideal candidates will have extensive experience in patient care and relevant board certifications. Enjoy a competitive salary and comprehensive benefits while making a difference in healthcare.

Benefits

Medical Plans

401(k)

Stock Purchase Plans

Wellness Programs

Paid Time Off

Flexible Schedules

Family Leave

Tuition Assistance

Qualifications

• Five or more years of experience providing direct patient care.
• Illinois state medical license without encumbrances.

Responsibilities

• Ensure timely responses to precertification and review requests.
• Involves prior authorization, concurrent review, and appeals.

Skills

Direct Patient Care

Utilization Management

Education

M.D.

D.O.

Job description

Join to apply for the Medical Director - Medicaid (IL) role at CVS Health

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 more connected, convenient, and compassionate. 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 including Illinois. This is a regional role primarily supporting the Aetna Better Health Plan of Illinois, supporting the UM (Utilization Management) team, but part of a centralized team supporting Illinois, Michigan, Kansas, and Oklahoma. Support for other regions may occasionally be required.

The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. Responsibilities include prior authorization, concurrent review, inpatient/outpatient services, pharmacy, appeals, and state fair hearings. The role involves a rotating on-call schedule for weekends and holidays.

Required Qualifications

• Five or more years of experience providing direct patient care.
• Illinois state medical license without encumbrances.
• M.D. or D.O., current and active Board Certification in ABMS or AOA recognized specialty, including post-graduate direct patient care experience.
• Board certification in Family Medicine, General Surgery, or Internal Medicine/Pediatrics.
• Prior UM experience at a health plan, insurer, as a Physician Advisor, or with an Independent Review Organization is a plus.

Preferred Qualifications

• Illinois residency preferred.
• Experience in health plan/payor Utilization Management/Review, Managed Care, and Medicaid.

Education

• M.D. or D.O.

Pay Range

The typical pay range for this role is $174,070.00 - $374,920.00, depending on experience, education, and location. This position is eligible for bonuses, incentives, and equity awards.

Benefits

Our comprehensive benefits include medical plans, 401(k), stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, tuition assistance, and more. For details, visit CVS Health Benefits.

Additional Information

Application deadline: 05/30/2025.

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

Job Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals and Health Care