Medical Director – Medicaid

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Provide support to Aetna Better Health of Louisiana and other health plans as required through centralized Medical Management.

• Collaborate with Medical Management personnel to guarantee timely, consistent, and clinically sound decisions for both members and providers.

• Execute utilization management and medical necessity assessments.

• Determine prior authorization and precertification outcomes.

• Conduct concurrent reviews for both inpatient and outpatient services.

• Perform evaluations for acute and post-acute care.

• Engage in peer-to-peer consultations with healthcare providers.

• Carry out pharmacy assessments and first-level appeal decisions.

• Work alongside multidisciplinary clinical and operational teams.

• Participate in a rotating on-call schedule that includes coverage on weekends and holidays.

⛳️ Requirements

• An active, unrestricted medical license is mandatory.

• Capability to obtain licensure in Florida and Kentucky.

• An M.D. or D.O. degree is required.

• Current, active Board Certification in a specialty recognized by ABMS or AOA.

• A minimum of 5 years of post-residency clinical practice and direct patient care experience is necessary.

• An active, unrestricted Louisiana medical license is preferred.

• Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics is preferred.

• Previous experience in Utilization Management within a health plan, managed care organization, Independent Review Organization, or as a Physician Advisor is preferred.

• Experience with Medicaid and managed care is preferred.

• Familiarity with medical necessity reviews, prior authorization, concurrent reviews, appeals, and peer-to-peer consultations is preferred.

• Experience with electronic health records and other clinical documentation systems is preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.