Medical Director - Medicaid, CVS Health

Medical Director - Medicaid

CVS Health

Location:

United States, Illinois

Category:

Health and Beauty

Contract Type:

Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

This UM Medical Director position primarily supports the Aetna Illinois Medicaid plan and the UM team. The role involves Utilization Management responsibilities, prior authorization, concurrent review, and participation in appeal requests and state fair hearings. CVS Health offers a comprehensive benefits package along with competitive compensation.

Job Responsibility:

Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request
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
Participate in a rotating on-call schedule for providing weekend and holiday coverage

Requirements:

Five or more years of experience providing direct patient care
Illinois 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 Family Medicine, General Surgery or Internal Medicine / Pediatrics
Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus +

Nice to have:

Preferred Illinois residency
Health plan/payor Utilization Management / Review experience
Managed Care experience
Medicaid experience

What we offer:

Medical, dental, and vision benefits
401(k) retirement savings plan
Employee Stock Purchase Plan
Fully-paid term life insurance plan
Short-term and long-term disability benefits
Well-being programs
Education assistance
Free development courses
CVS store discount
Discount programs with participating partners
Paid Time Off (PTO)
Paid holidays

Additional Information:

Job Posted:

March 19, 2025

Expiration:

April 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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