Aetna operates Medicaid Managed Care Plans in multiple states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and West Virginia. This is a regional role that primarily supports the Aetna Better Health Plan of Oklahoma.

This UM (Utilization Management) Medical Director will be a "Work from Home" position primarily supporting the Aetna Oklahoma plan; but part of a centralized team that supports Illinois, Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required.

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 coverage.

Required Qualifications:

- Five or more years of experience providing direct patient care.

- Oklahoma state medical license without encumbrances

- 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 Internal Medicine/Pediatrics, Internal Medicine, or Family Medicine

- 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:

-Preferred Oklahoma residency

-Health plan/payor Utilization Management / Review experience.
-Managed Care experience.

-Medicaid experience.

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.

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.