CVS Health
Medical Director-Medicaid (ABH VA)
$174K–$375K
VA - Work from home +8 · Remote · Director · Full-time · Posted Oct 28, 2026
- Location
- VA - Work from home
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Work At Home-Tennessee - Experience
- 5+ years of post-residency clinical practice and direct patient care experience.
- Education
- M.D. or D.O.; board certification in an ABMS- or AOA-recognized specialty.
About the job
Provides clinical oversight and medical necessity decisions for Medicaid members, primarily supporting Aetna Better Health of Virginia and other regional health plans.
What you'll do
- Conduct utilization management, prior authorization, concurrent, acute, post-acute, pharmacy, and appeal reviews.
- Consult with treating providers through peer-to-peer discussions and collaborate with clinical and operational teams.
- Participate in a rotating on-call schedule, including weekends and holidays.
What they ask for
- M.D. or D.O. degree and 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.
Nice to have
- Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics.
- Experience in utilization management, Medicaid or managed care, medical reviews and appeals, peer-to-peer consultation, or clinical documentation systems.
Pay
$174,070.00 - $374,920.00 USD base salary
Tools
electronic health records
Model-written summary · the original posting is authoritative