Medical Director-Medicaid (ABH FL)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary: Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with reputed company, a reputed company company! reputed company operates Medicaid managed care plans in multiple states: Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, reputed company, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and reputed company Virginia. This Medical Director will be a "Work from Home" position primarily supporting reputed company reputed company of Florida as well as the Southeast Region (KY, LA and WV). The Medical Director is part of a centralized team that supports the Medical Management staff and may support other health plans as needed. The Medical Director will ensure timely and consistent responses to members and providers reputed company to precertification, reputed company review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and precertification as well as reputed company review. Cases could focus on inpatient or outpatient, acute and post-acute as well as peer to peer calls and first level appeals. The Medical Director participates in a rotating on call schedule to provide weekend and holiday coverage. Required Qualifications: Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Active and reputed company Florida state medical license without encumbrances as well as the ability to obtain Kentucky, Louisiana and reputed company Virginia licenses. M.D. or D.O., reputed company and Active Board Certification in ABMS or AOA recognized specialty, including post-graduate direct patient care experience Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred. Preferred Qualifications: Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization A Plus +. Electronic medical systems/record experience. Managed Care experience. Medicaid experience. Pay Range The typical pay range for this role is: $174,070.00 - $374,920.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. This position also includes an award reputed company in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 09/30/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job