Medical Director-Medicaid (ABH VA)
职位标题：医疗监督管理局 (ABH VA) 工作地点：在家工作，弗吉尼亚州，美国工作地点类型：远程工作合同类型：全日制工作资深级别：我们正在围绕每个人建立一个健康世界塑造更连接，方便和有慈悲的健康体验。在 CVS Health®,你会被热情的同事包围，他们关心深刻，有目的地创新，让自己负责并优先考虑安全和质量在所有事情中。加入我们并成为一些更大的的一部分帮助一次简化卫生保健一个人，一个家庭和一个社区。职位摘要：这是一个全日制，完全远程角色。你可以从美国任何地方工作。加入 CVS 健康公司 Aetna,并对全国各地的医疗补助成员的健康和福祉产生有意义的影响.Aetna 在亚利桑那州，佛罗里达州，伊利诺伊州，肯塔基州，路易斯安纳州，马里兰州，密歇根州，新泽西州，纽约州，俄俄州，奥克拉荷马州，宾夕法尼亚州，德克萨斯州，弗吉尼亚州和西部弗吉尼亚省运营了医疗补救计划。我们正在寻找一名医学总监加入我们的集中化医疗管理团队。这项家庭职位将主要支持维吉尼亚州 Aetna 更好的健康，同时也提供东北地区 （马里兰地，新泽赛州，纽约和宾夕法尼亞州）和其他卫生计划的支持。在这个角色中，你将与医疗管理人员合作，确保成员和提供商的及时，一致和临床合理决策。主要责任包括：· 利用管理和医疗必要性审查 · 预先授权和预认证确定 · 入院和外诊服务的同时评估 · 急症和后急症护理审查 · 与治疗提供商进行同行咨询 · 药房评审和第一级上诉决定 · 与多学科临床和运营团队协作医疗总监还参与了一个轮流的呼叫时间表，其中包括周末和假期覆盖。如果你是一名热衷于改善医疗补助人口质量，获得和结果的医生领导者，我们很想与你联系。要求：· MD 或 DO 学位，目前在 ABMS 或 AO 认可专业中具有活跃的董事会证书。· 5年以上后住院临床实践和直接护理患者经验。·积极无限制的弗吉尼亚州医学执照。· 获得一个免费许可证。
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Job Title: Medical Director-Medicaid (ABH VA)
Job Location: Work at Home, Virginia, United States
Job Location Type: Remote
Job Contract Type: Full-time
Job Seniority Level:
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary:
This is a full-time, fully remote role. You can work from anywhere in the United States.
Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country.
Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia.
We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Virginia, while also providing support across the Northeast Region (Maryland, New Jersey, New York, and Pennsylvania) and other health plans as needed.
In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include:
- Utilization Management and medical necessity reviews
- Prior authorization and precertification determinations
- Concurrent review for inpatient and outpatient services
- Acute and post-acute care reviews
- Peer-to-peer consultations with treating providers
- Pharmacy reviews and first-level appeal determinations
- Collaboration with multidisciplinary clinical and operational teams
The Medical Director also participates in a rotating on-call schedule that includes weekend and holiday coverage.
If you are a physician leader who is passionate about improving quality, access, and outcomes for Medicaid populations, we would love to connect with you.
Required Qualifications:
- M.D. or D.O. degree with current, active Board Certification in an ABMS- or AOA-recognized specialty.
- 5+ years of post-residency clinical practice and direct patient care experience.
- Active, unrestricted Virginia medical license.
- Ability to obtain and maintain medical licenses in Maryland, New Jersey, New York and Pennsylvania.
Preferred Qualifications:
- Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics.
- Prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor capacity.
- Medicaid and managed care experience.
- Experience with medical necessity review, prior authorization, concurrent review, appeals, and peer-to-peer consultation.
- Experience using electronic health records and other clinical documentation systems.
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 - $374,920.00This 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 people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/15/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Originally posted on Himalayas