Skip to content
Medical Director – Medicaid
| Company | CVS Health |
|---|
| Location | Illinois, USA |
|---|
| Salary | $174070 – $374920 |
|---|
| Type | Full-Time |
|---|
| Degrees | MD |
|---|
| Experience Level | Senior |
|---|
Requirements
- Five or more years of experience providing direct patient care.
- Illinois 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 or Internal Medicine / Pediatrics
- Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus +
Responsibilities
- Ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.
- Responsible for Utilization Management, including prior authorization as well as concurrent review.
- Focus on inpatient or outpatient services, acute and post acute services, pharmacy, appeals and state fair hearings.
- Part of a rotating on call schedule for providing weekend and holiday coverage.
Preferred Qualifications
- Preferred Illinois residency
- Health plan/payor Utilization Management / Review experience.
- Managed Care experience.
- Medicaid experience.
