# Medical Director

**Company**: Aetna, a CVS Health company
**Location**: LA, LA
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $174,070.00 - $374,920.00
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/LA---Work-from-home/Medical-Director---Medicaid---Aetna-Better-Health-of-Louisiana_R1077011?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_85f43825-0f7

## Description

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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.

**This position prefers an active, unrestricted Louisiana medical license**

**Position Summary:** Ready to take your Medical Director career to the next level with a Fortune 6 company?

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 West Virginia.

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 Louisiana, while also providing support across the 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 include:

- Conducting utilization management and medical necessity reviews

- Making prior authorization and precertification determinations

- Performing concurrent reviews for inpatient and outpatient services

- Reviewing acute and post-acute care

- Engaging in peer-to-peer consultations with treating providers

- Conducting pharmacy reviews and first-level appeal determinations

- Collaborating with multidisciplinary clinical and operational teams

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

If you are a physician leader who is passionate about improving quality, access, and outcomes for Medicaid populations, we would love to connect with you.

**Required Qualifications:**

- Active, unrestricted medical license

- Ability to be licensed in Florida and Kentucky

- 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

**Preferred Qualifications:**

- Active, unrestricted Louisiana medical license

- 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:** MD or DO

**Pay Range:** $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:** 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.

## Skills

### Required
- M.D. or D.O.
- Board Certification
- clinical practice
- patient care
- medical license
- utilization management

### Nice to have
- Louisiana medical license
- Family Medicine
- Emergency Medicine
- Internal Medicine-Pediatrics
- Utilization Management experience
- Medicaid experience
- managed care experience

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/LA---Work-from-home/Medical-Director---Medicaid---Aetna-Better-Health-of-Louisiana_R1077011?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)