Medical Director-Medicaid (ABH-WV)

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. Position Summary: Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid managed care plans in multiple states: Arizona, California, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and West Virginia. This supports the Aetna Better Health of West Virginia primarily This Medical Director role will be a "Work from Home" position primarily supporting the Aetna West Virginia plan, and the Southeast Region (FL, KY and LA). The Medical Director is part of a centralized team that supports the Medical Management staff and may support other health plans as needed. The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and precertification 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. The Medical Director participates in a rotating on call schedule to provide weekend and holiday coverage. Required Qualifications: - Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. - Active and current West Virginia state medical license without encumbrances as well as the ability to obtain Florida, Louisiana and Kentucky licenses. - M.D. or D.O., Current and Active Board Certification in ABMS or AOA recognized specialty; including post-graduate direct patient care experience - Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics 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., 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. 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 people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. Apply tot his job Apply To this Job