Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia adding Oklahoma. This role supports the Aetna Better Health of Florida primarily, and the Southeast Region (KY, LA and WV).

This Medical Director will be a "Work from Home" position primarily supporting the Aetna Florida plan; but part of a centralized team that supports the Medical Management staff.

The 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 and pre certification as well as concurrent review. Cases could focus on inpatient or outpatient, acute and post acute as well as peer to peer calls and first level appeals.

Required Qualifications:

- Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.

- Active and current Florida state medical license without encumbrances as well as the ability to obtain a Kentucky, Louisiana and West Virginia.

- M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty; including post-graduate direct patient care experience

- Pediatrics, Internal Medicine-Pediatric, Family Medicine Specialty Preferred.

- Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus +

Preferred Qualifications:

-Health plan/payor Utilization Management / Review experience.

-Electronic medical systems/record experience.
-Managed Care experience.

-Medicaid experience.

Education:

-M.D. or D.O., Board Certification in ABMS or AOA recognized specialty including post-graduate direct patient care experience.

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/29/2024

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