Medical Director - Medicaid Virginia (Richmond)
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At CVS Health, were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Ready to take your Medical Director skills to the next level with a Fortune 6 company? Check out this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states including Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia. This is a regional role supporting Medicaid plans primarily in Aetnas Northeast region, but may support other plans when needed. The UM (Utilization Management) Medical Director will be a Work from Home position supporting the Virginia Medicaid plan and the UM team. The UM Medical Director will oversee responses to members and providers regarding precertification, concurrent review, and appeals. Responsibilities include Utilization Management, prior authorization, and concurrent review for inpatient/outpatient services, pharmacy, appeals, and hearings. A rotating on-call schedule for weekends and holidays is required. Required Qualifications- Five or more years of experience providing direct patient care.
- Active state medical license without encumbrances and willingness to obtain additional licenses as needed.
- M.D. or D.O., with current Board Certification in ABMS or AOA recognized specialty, including post-graduate direct patient care experience.
- Preferred specialties include Emergency Medicine, Family Medicine (with hospitalist experience), General Surgery, or Internal Medicine.
- Physician leadership experience.
- M.D. or D.O.
The typical pay range for this role is $174,070.00 - $374,920.00 . The actual offer depends on experience, education, location, and other factors. The position is eligible for bonuses, incentives, and equity awards.
Our colleagues are our future. We foster an inclusive workplace where everyone feels valued and belongs.
Benefits- Medical options, 401(k) with match, stock purchase plan.
- No-cost wellness, tobacco cessation, counseling, financial coaching.
- Flexible schedules, paid time off, family leave, dependent care, tuition assistance, and more.
More info:
Application closes on: 08/29/2025
Qualified applicants with criminal records will be considered per law.
Seniority level
- Director
Employment type
- Full-time
Job function
- Health Care Provider
Industries
- Hospitals and Health Care
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