Medical Director-Medicaid (ABH-LA)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This positions requires an active, unrestricted Louisiana medical license ***Position SummaryReady to take your Medical Director career to the next level with a Fortune 6 company?Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country.Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia.We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Louisiana, while also providing support across the other health plans as needed.ResponsibilitiesIn this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include:Utilization Management and medical necessity reviewsPrior authorization and precertification determinationsConcurrent review for inpatient and outpatient servicesAcute and post-acute care reviewsPeer-to-peer consultations with treating providersPharmacy reviews and first-level appeal determinationsCollaboration with multidisciplinary clinical and operational teamsThe Medical Director also participates in a rotating on-call schedule that includes weekend and holiday coverage.If you are a physician leader who is passionate about improving quality, access, and outcomes for Medicaid populations, we would love to connect with you.Required QualificationsActive, unrestricted Louisiana medical license.The ability to be licensed in Florida and KentuckyM.D. or D.O. degree with current, active Board Certification in an ABMS- or AOA-recognized specialty.5+ years of post-residency clinical practice and direct patient care experience.Preferred QualificationsBoard 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.EducationMD or DOPay RangeThe Typical Pay Range For This Role Is$174,070.00 - $374,920.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great Benefits For Great PeopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.We anticipate the application window for this opening will close on: 10/24/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.