Medical Director (Aetna Medicaid)

Job DescriptionReady to take your Medical Director skills to the next level with a Fortune 5 company? Check out this opportunity with Aetna, a CVS Health companyAetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia.This role supports the Aetna Medicaid Southeast region of Florida, Kentucky, Louisiana, Ohio and West Virginia. This Medical Director will be a "Work from Home" position primarily supporting the Aetna Better Health of Florida 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.Required Qualifications- Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.-Active and current FLORIDA medical license without encumbrances-M.D. or D.O., Current and Active Board Certification in recognized specialty including post-graduate direct patient care experience- Internal Medicine, Family Medicine, Emergency Medicine 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 +COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications-Health plan/payor experience.-Electronic medical systems/record experience-Managed Care experienceEducation-M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15