Medical Director – Duals Center of Excellence

CVS Health

Medical Director at Aetna Duals Center of Excellence overseeing dual integrated plans and Medicare ISNP Plans. Ensuring timely responses to medical management inquiries and leading utilization management efforts.

Posted 5/15/2026full-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
CVS Health bonus, commission or short-term incentive program

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical practiceutilization reviewauthorization reviewspharmacy reviews

Soft Skills

leadershipcommunication

Certifications

MDDOboard certificationstate medical license