Medical Director - Medicaid Northeast

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 uniquely more connected, more convenient and more compassionate. And 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? Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states : Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and West Virginia. This is a regional role that primarily supports Medicaid plans in Aetna's Northeast region but may support other plans when needed. This UM (Utilization Management) Medical Director will be a Work from Home position primarily supporting the Aetna Northeast Medicaid plan and the UM team. The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent review. Cases could focus on inpatient or outpatient services, acute and post-acute services, pharmacy, appeals and state fair hearings. You will be part of a rotating on call schedule for providing weekend and holiday coverage.

Required Qualifications

• Five or more years of experience providing direct patient care.
• Active state medical license without encumbrances and the willingness to get licensure in other states as needed.
• 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 Physical Medicine & Rehabilitation, Emergency Medicine, Family Medicine (with hospitalist experience) or Internal Medicine preferred.

Preferred Qualifications

Education

M.D. or D.O.

Pay Range

The typical pay range for this role is : $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.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

For more information, visit https : / / jobs.cvshealth.com / us / en / benefits

We anticipate the application window for this opening will close on : 11 / 28 / 2025.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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