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Medical Director - Kentucky Medicaid - Remote Eligible

Lead Utilization Management for the Aetna Better Health of Kentucky Medicaid program.
Remote
Senior
$174,070 - 374,920 USD / year
2 weeks ago
CVS Health

CVS Health

CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.

✨ About The Role

- This position primarily supports the Aetna Better Health of Kentucky and the Southeast Region, including Florida, Louisiana, and West Virginia. - The Medical Director will work from home and be part of a centralized team that supports the Medical Management staff. - Responsibilities include ensuring timely responses to members and providers regarding precertification, concurrent review, and appeal requests. - The role involves managing cases related to inpatient and outpatient care, including acute and post-acute settings. - The Medical Director will engage in peer-to-peer calls and first-level appeals as part of their duties.

âš¡ Requirements

- The ideal candidate will have at least five years of experience in the healthcare delivery system, demonstrating a strong understanding of clinical practice and the healthcare industry. - A current and active medical license in Kentucky is required, along with the ability to obtain licenses in Florida, Louisiana, and West Virginia. - Candidates should possess an M.D. or D.O. degree and hold current board certification in an ABMS or AOA recognized specialty. - Experience in Utilization Management, particularly in prior authorization and concurrent review, is essential for success in this role. - The successful candidate will have a background in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics, which is preferred.
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Medical Director - Kentucky Medicaid - Remote Eligible
Remote
$174,070 - 374,920 USD / year
Healthcare Administration
About CVS Health
CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.