# Medical Director

**Company**: CVS Health
**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/CT---Work-from-home/Medical-Director-Aetna-Duals-Center-of-Excellence_R1089399?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_f178da8b-110

## Description

We are seeking a Medical Director to join our Aetna Duals Center of Excellence team. As a Medical Director, you will be part of a centralized team that supports Medical Management staff in ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This is a work-at-home position located anywhere in the US.

The Medical Director will work a full-time schedule, Monday to Friday, in Eastern Standard Time or Central Standard Time, 8:00 AM - 5:00 PM. You will also be expected to work 1 holiday and 8 weekend days (approximately 1 weekend per quarter) each year.

Key responsibilities include:

- Performing concurrent and prior authorization reviews with peer-to-peer coverage of denials

- Conducting appeals in 'base plans' and potentially participating in round-robin reviews based on 'same or similar specialty' needs

- Reviewing pharmacy coverage

- Participating in and leading rounds

Requirements:

- Minimum 3-5 years of clinical practice experience

- Two (2) + years of experience in managed care (Medicare and/or Medicaid)

- Experience with utilization management (preferred Medicare and/or Medicaid)

- MD or DO; Board certification in an ABMS or AOA recognized specialty is required

- Active and current state medical license without encumbrances is required; multiple state licensure a plus

- Florida license or ability to obtain

Preferred qualifications:

- Previous experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System

- Licensed in or willing to obtain a license in at least one state where we have an Integrated plan

The typical pay range for this role is: $174,070.00 - $374,920.00 per year. This position is eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.

## Skills

### Required
- utilization management
- managed care
- Medicaid
- Medicare
- MD
- DO
- ABMS
- AOA

### Nice to have
- Utilization Management / Claims Determination
- multiple state licensure
- Integrated plan licensure

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Work-from-home/Medical-Director-Aetna-Duals-Center-of-Excellence_R1089399?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)