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and West Virginia and Oklahoma.This role supports the Aetna Better Health of West Virginia primarily, and the Southeast Region (FL, KY and LA).This Medical Director will be a "Work from Home" position primarily supporting the Aetna West Virginia plan; but part of a centralized team that supports the Medical Management staff.The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.This position is primarily responsible for Utilization Management, including prior authorization and pre certification 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.
Required Qualifications:
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., Board Certification in ABMS or AOA recognized specialty including post-graduate direct patient care experience.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 peopleWe 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:
For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 07/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.