Remote Medical Director, Medicaid Quality Lead

CVS Health; Baton Rouge (LA); Remoto; USD 174.000 - 375.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Dental coverage

Vision coverage

Retirement plan

Descrizione del lavoro

CVS Health, through its Aetna Better Health Louisiana program, seeks a Medical Director to advance Medicaid quality, access and outcomes. This work‑from‑home role supports Louisiana while assisting other plans as needed, driving utilization management and care reviews.

Eligible physicians will lead with integrity and collaborate across clinical and operational teams. Required: active medical license, Board certification, and 5+ years of direct patient care.

Competenze

• Active, unrestricted medical license.
• Board certification in ABMS- or AOA-recognized specialty.
• 5+ years of post-residency clinical practice and direct patient care.
• Licensure eligibility in Louisiana, and ability to license in FL and KY.

Mansioni

• 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.
• Collaborate with multidisciplinary clinical and operational teams.

Conoscenze

Medical license

Board Certification

Clinical experience

On-call experience

Formazione

MD or DO

Descrizione del lavoro

CVS Health, through its Aetna Better Health Louisiana program, seeks a Medical Director to advance Medicaid quality, access and outcomes. This work‑from‑home role supports Louisiana while assisting other plans as needed, driving utilization management and care reviews.

Eligible physicians will lead with integrity and collaborate across clinical and operational teams. Required: active medical license, Board certification, and 5+ years of direct patient care.