Medical Director – Aetna Duals Center of Excellence

CVS Health

Medical Director for Aetna's Duals Integrated Plans, ensuring timely responses to medical management inquiries. Requires engagement in utilization management and appeals with flexible working hours across various US states.

Posted 5/3/2026full-timeRemote • Illinois, Mississippi, Oklahoma, Texas • 🇺🇸 United StatesLead💰 $174,070 - $374,920 per yearWebsite

About the role

Key responsibilities & impact

perform concurrent and prior authorization reviews with peer to peer coverage of denials.
perform appeals in their 'base plans' and may round robin based on 'same or similar specialty' needs.
perform pharmacy reviews.
participate in and be able to lead rounds.

Requirements

What you’ll need

Minimum 3-5 years of clinical practice experience.
Two (2) + years of experience in managed care (Medicare and/or Medicaid)
Experience with managed care (Medicare and Medicaid) utilization review preferred
MD or DO; Board certification in an ABMS or AOA recognized specialty is required.
Active and current state medical license without encumbrances is required.
Multiple state licensure a plus.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical practicemanaged careutilization reviewauthorization reviewspharmacy reviewspeer to peer coverageappeals processing

Soft Skills

leadershipcollaboration

Certifications

MDDOboard certificationactive state medical license