Medical Director – Kentucky Medicaid

CVS Health

Medical Director position for Aetna (CVS Health), focusing on utilization management in Kentucky. Ensuring efficient healthcare delivery in a remote role with a centralized team.

Posted 5/3/2026full-timeRemote • Kentucky • 🇺🇸 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
ensure Utilization Management, including prior authorization and pre certification as well as concurrent review
focus on inpatient or outpatient, acute and post acute as well as peer to peer calls and first level appeals

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 Kentucky state medical license without encumbrances as well as the ability to obtain a Florida, Louisiana and West Virginia
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 +
Health plan/payor Utilization Management / Review experience
Electronic medical systems/record experience
Managed Care experience
Medicaid experience.

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

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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 care experienceHealth plan/payor Utilization Managementelectronic medical systemsMedicaid experience

Certifications

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