Medical Director - Medicaid - Aetna Better Health of Louisiana
CVS Health•Work At Home-Louisiana, LA
•$174,070 - $374,920•Remote
About The Position
Aetna, a CVS Health company, is seeking a Medical Director for its centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Louisiana and may provide support across other Aetna Medicaid health plans as needed. The role partners with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. The Medical Director also participates in a rotating on-call schedule that includes weekend and holiday coverage.
Requirements
- Active, unrestricted medical license.
- Ability to be licensed in Florida and Kentucky.
- M.D. or D.O. degree.
- Current, active board certification in an ABMS- or AOA-recognized specialty.
- At least 5 years of post-residency clinical practice and direct patient care experience.
Nice To Haves
- 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.
Responsibilities
- Conduct utilization management and medical necessity reviews.
- Make prior authorization and precertification determinations.
- Perform concurrent reviews for inpatient and outpatient services.
- Conduct acute and post-acute care reviews.
- Provide peer-to-peer consultations with treating providers.
- Conduct pharmacy reviews and first-level appeal determinations.
- Collaborate with multidisciplinary clinical and operational teams.
- Participate in a rotating on-call schedule that includes weekend and holiday coverage.
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission, or short-term incentive program eligibility
- Award target in the company’s equity award program
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
