Medical Director – Medicaid

CVS Health

Medical Director for Aetna managing Medicaid services from home primarily in Louisiana and surrounding regions. Oversee Utilization Management and ensure compliance with care guidelines remotely across states.

Posted 5/3/2026full-timeRemote • Florida, Kentucky, Louisiana, Maryland, Virginia, West Virginia • 🇺🇸 United StatesLead💰 $174,070 - $374,920 per yearWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Active and current Louisiana state medical license without encumbrances as well as the ability to obtain Florida, Kentucky and West Virginia 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 Required.
Health plan/payor Utilization Management / Review experience.
Electronic medical systems/record experience.
Managed Care experience.
Medicaid experience.
Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus +

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Utilization Managementprecertificationconcurrent reviewprior authorizationpeer to peer callsfirst level appealspost-graduate direct patient careHealth plan/payor Utilization ManagementMedicaid experienceManaged Care experience

Certifications

Louisiana state medical licenseM.D.D.O.Current and Active Board Certification in ABMS or AOA recognized specialty