Medical Director

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 themselves accountable and prioritize safety and quality in everything we do.

Position Summary: Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

This is a remote based (work from home) position for the Georgia and Gulf States Region (LA, MS, AL, and AR). The preferred candidate will reside in one of these states. Even if the candidate does not reside in one of these states, the candidate should have the ability to learn about this market – hospitals, outpatient networks, and value-based care relationships.

Responsibilities:

• As a Medical Director you will focus primarily on overseeing utilization review and quality evaluation of inpatient hospitalizations, prior authorizations, and appeals.
• You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
• You will support the Medical Management staff ensuring timely and consistent responses to members and providers. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.

Required Qualifications:

• Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
• Active and current medical license without encumbrances.
• M.D. or D.O., Active and Current Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
• Experience with technology such as Microsoft Outlook and Teams.

Preferred Qualifications:

• Residence in one of the states in the Georgia and Gulf States Region (LA, MS, AL, and AR)
• Previous UM experience with a Health Plan / Payor.
• Previous UM experience as a Physician Advisor in a Health / Hospital system.
• Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine Preferred.

Education:

• Medical Doctor or Doctor of Osteopathic Medicine

Pay Range: $174,070.00 - $374,920.00

Benefits: 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.