CVS Health
Medical Director - Medicaid - Aetna Better Health of Louisiana
$174K–$375K
LA - Work from home · Remote · Director · Full-time · Posted Oct 19, 2026
- Experience
- 5+ years of post-residency clinical practice and direct patient care experience.
- Education
- MD or DO
About the job
Provides clinical oversight and medical necessity reviews for Medicaid members, primarily supporting Aetna Better Health of Louisiana and other health plans as needed.
What you'll do
- Conduct utilization management, prior authorization, concurrent, acute, and post-acute care reviews and determinations.
- Perform peer-to-peer consultations, pharmacy reviews, and first-level appeal determinations.
- Collaborate with clinical and operational teams and participate in rotating weekend and holiday on-call coverage.
What they ask for
- Active, unrestricted medical license; ability to be licensed in Florida and Kentucky.
- 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.
Nice to have
- Active, unrestricted Louisiana medical license; board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics.
- Experience in utilization management, Medicaid or managed care, medical necessity review, authorizations, appeals, peer-to-peer consultation, or clinical documentation systems.
Pay
$174,070.00 - $374,920.00 USD (base hourly rate or base annual full-time salary)
Tools
electronic health records
Model-written summary · the original posting is authoritative