CVS Health
Medical Director - Medicaid (Oklahoma)
CVS Health, Oklahoma City, Oklahoma, United States, 73116
Medical Director – Medicaid (Oklahoma) – CVS Health
Position Summary
Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states. This is a regional role that primarily supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a “Work from Home” position primarily supporting the Aetna Oklahoma Medicaid plan and the UM team; but part of a centralized team that supports Illinois, Michigan and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and concurrent review. Cases could focus on inpatient or outpatient services, acute and post acute services, pharmacy, appeals and state fair hearings. You will be part of a rotating on‑call schedule for providing weekend and holiday coverage. Required Qualifications
Five or more years of experience providing direct patient care. Oklahoma state medical license without encumbrances. M.D. or D.O., current and active board certification in ABMS or AOA‑recognized specialty, including post‑graduate direct patient care experience. Board certification in Family Medicine, General Surgery or Internal Medicine / Pediatrics. Prior UM experience working at a health plan/insurer or experience as a physician advisor or working for an independent review organization. Preferred Qualifications
Preferred Oklahoma residency. Health plan/payor utilization management / review experience. Managed care experience. Medicaid experience. Education
M.D. or D.O. Pay Range & Compensation
The typical pay range for this role is $174,070.00 – $374,920.00. This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Benefits
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No‑cost programs for all 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. We anticipate the application window for this opening will close on: 01/30/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Seniority Level
Mid‑Senior level Employment Type
Full‑time Job Function
Health Care Provider Industries
Hospitals and Health Care
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Position Summary
Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states. This is a regional role that primarily supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a “Work from Home” position primarily supporting the Aetna Oklahoma Medicaid plan and the UM team; but part of a centralized team that supports Illinois, Michigan and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and concurrent review. Cases could focus on inpatient or outpatient services, acute and post acute services, pharmacy, appeals and state fair hearings. You will be part of a rotating on‑call schedule for providing weekend and holiday coverage. Required Qualifications
Five or more years of experience providing direct patient care. Oklahoma state medical license without encumbrances. M.D. or D.O., current and active board certification in ABMS or AOA‑recognized specialty, including post‑graduate direct patient care experience. Board certification in Family Medicine, General Surgery or Internal Medicine / Pediatrics. Prior UM experience working at a health plan/insurer or experience as a physician advisor or working for an independent review organization. Preferred Qualifications
Preferred Oklahoma residency. Health plan/payor utilization management / review experience. Managed care experience. Medicaid experience. Education
M.D. or D.O. Pay Range & Compensation
The typical pay range for this role is $174,070.00 – $374,920.00. This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Benefits
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No‑cost programs for all 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. We anticipate the application window for this opening will close on: 01/30/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Seniority Level
Mid‑Senior level Employment Type
Full‑time Job Function
Health Care Provider Industries
Hospitals and Health Care
#J-18808-Ljbffr