{"version":"0.1","company":{"name":"YubHub","url":"https://yubhub.co","jobsUrl":"https://yubhub.co/jobs/at/aetna-a-cvs-health-company/"},"x-facet":{"type":"company","slug":"aetna-a-cvs-health-company","display":"Aetna, a CVS Health Company","count":5},"x-feed-size-limit":100,"x-feed-sort":"enriched_at desc","x-feed-notice":"This feed contains at most 100 jobs (the most recently enriched). For the full corpus, use the paginated /stats/by-facet endpoint or /search.","x-generator":"yubhub-xml-generator","x-rights":"Free to redistribute with attribution: \"Data by YubHub (https://yubhub.co)\"","x-schema":"Each entry in `jobs` follows https://schema.org/JobPosting. YubHub-native raw fields carry `x-` prefix.","jobs":[{"@context":"https://schema.org","@type":"JobPosting","identifier":{"@type":"PropertyValue","name":"YubHub","value":"job_85f43825-0f7"},"title":"Medical Director","description":"<p>We&#39;re building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.</p>\n<p>At CVS Health, you&#39;ll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.</p>\n<p><strong>This position prefers an active, unrestricted Louisiana medical license</strong></p>\n<p><strong>Position Summary:</strong> Ready to take your Medical Director career to the next level with a Fortune 6 company?</p>\n<p>Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country.</p>\n<p>Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia.</p>\n<p>We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Louisiana, while also providing support across the other health plans as needed.</p>\n<p>In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include:</p>\n<ul>\n<li>Conducting utilization management and medical necessity reviews</li>\n<li>Making prior authorization and precertification determinations</li>\n<li>Performing concurrent reviews for inpatient and outpatient services</li>\n<li>Reviewing acute and post-acute care</li>\n<li>Engaging in peer-to-peer consultations with treating providers</li>\n<li>Conducting pharmacy reviews and first-level appeal determinations</li>\n<li>Collaborating with multidisciplinary clinical and operational teams</li>\n</ul>\n<p>The Medical Director also participates in a rotating on-call schedule that includes weekend and holiday coverage.</p>\n<p>If you are a physician leader who is passionate about improving quality, access, and outcomes for Medicaid populations, we would love to connect with you.</p>\n<p><strong>Required Qualifications:</strong></p>\n<ul>\n<li>Active, unrestricted medical license</li>\n<li>Ability to be licensed in Florida and Kentucky</li>\n<li>M.D. or D.O. degree with current, active Board Certification in an ABMS- or AOA-recognized specialty</li>\n<li>5+ years of post-residency clinical practice and direct patient care experience</li>\n</ul>\n<p><strong>Preferred Qualifications:</strong></p>\n<ul>\n<li>Active, unrestricted Louisiana medical license</li>\n<li>Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics</li>\n<li>Prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor capacity</li>\n<li>Medicaid and managed care experience</li>\n<li>Experience with medical necessity review, prior authorization, concurrent review, appeals, and peer-to-peer consultation</li>\n<li>Experience using electronic health records and other clinical documentation systems</li>\n</ul>\n<p><strong>Education:</strong> MD or DO</p>\n<p><strong>Pay Range:</strong> $174,070.00 - $374,920.00</p>\n<p>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&#39;s equity award program.</p>\n<p><strong>Benefits:</strong> We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.</p>\n<p>This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. 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$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.</p>\n<p><strong>Benefits</strong> We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.</p>\n<p style=\"margin-top:24px;font-size:13px;color:#666;\">Job Data by <a href=\"https://yubhub.co\">YubHub</a>.</p>","url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/FL---Work-from-home/Medical-Director---Florida--3-_R1071470","directApply":true,"hiringOrganization":{"@type":"Organization","name":"Aetna, a CVS Health Company","sameAs":"https://cvshealth.com","logo":"https://logos.yubhub.co/cvshealth.com.png"},"x-apply-url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/FL---Work-from-home/Medical-Director---Florida--3-_R1071470","x-work-arrangement":"remote","x-experience-level":"senior","x-job-type":"full-time","x-salary-range":"$174,070.00 - $374,920.00","x-skills-required":["Clinical Practice","Health Care Industry","Medical Policy Implementation","Utilization Review","Quality Assurance"],"x-skills-preferred":["UM experience with a Health Plan/Payor"],"x-benefits":["pension","health_insurance","dental","paid_leave","bonus","equity"],"x-licences":[],"x-visa-sponsorship":"unknown","x-visa-sponsorship-text":null,"x-work-authorisation":"unknown","x-work-authorisation-text":null,"datePosted":"2026-10-20T00:00:00.000Z","jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Work from home, FL"}},"jobLocationType":"TELECOMMUTE","employmentType":"FULL_TIME","occupationalCategory":"Healthcare","industry":"Healthcare","skills":"Clinical Practice, Health Care Industry, Medical Policy Implementation, Utilization Review, Quality Assurance, UM experience with a Health Plan/Payor","baseSalary":{"@type":"MonetaryAmount","currency":"USD","value":{"@type":"QuantitativeValue","minValue":174070,"maxValue":374920,"unitText":"YEAR"}}},{"@context":"https://schema.org","@type":"JobPosting","identifier":{"@type":"PropertyValue","name":"YubHub","value":"job_e5380dd0-661"},"title":"Medical Director (Behavioral Health)","description":"<p>We&#39;re building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.</p>\n<p>This is a remote-based (work from home) role, preferably for candidates residing in Ohio.</p>\n<p>As Medical Director (Behavioral Health), you will provide leadership and day-to-day physician oversight for the utilization management team, including managing high-risk cases and medical necessity decisions.</p>\n<p>Key responsibilities:</p>\n<ul>\n<li>Provide comprehensive behavioral health care management to ensure quality care and improve program efficiency</li>\n<li>Participate in the appeals process, investigating adverse events and quality of care concerns</li>\n<li>Offer psychiatric leadership to an interdisciplinary utilization management team</li>\n<li>Assist with developing, implementing, and evaluating the utilization management program</li>\n<li>Collaborate with behavioral health practitioners regarding patient care</li>\n<li>Identify and address quality of care concerns with providers</li>\n<li>Provide psychiatric leadership for clinical quality improvement activities</li>\n<li>Participate in triage and referral for care management</li>\n<li>Provide weekend coverage every 6-7 weeks</li>\n</ul>\n<p>Required qualifications:</p>\n<ul>\n<li>Board-certified Psychiatrist, currently licensed in Ohio or able to obtain licensure</li>\n<li>Active state medical license without encumbrances</li>\n<li>Ability to obtain additional state licensures for UM coverage across multiple state health plans</li>\n</ul>\n<p>Preferred qualifications:</p>\n<ul>\n<li>Reside in Ohio</li>\n<li>Minimum 5 years of clinical practice experience as a psychiatrist</li>\n<li>Experience with managed care, utilization review, or physician advisor experience</li>\n<li>Child/Adolescent Board Certification</li>\n</ul>\n<p>The typical pay range for this role is: $174,070.00 - $374,920.00 per year.</p>\n<p>We offer a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs.</p>\n<p style=\"margin-top:24px;font-size:13px;color:#666;\">Job Data by <a href=\"https://yubhub.co\">YubHub</a>.</p>","url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OH---Work-from-hom/Medical-Director---Behavioral-Health---ABH-OH_R1040915-1","directApply":true,"hiringOrganization":{"@type":"Organization","name":"Aetna, a CVS Health Company","sameAs":"https://cvshealth.com","logo":"https://logos.yubhub.co/cvshealth.com.png"},"x-apply-url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OH---Work-from-hom/Medical-Director---Behavioral-Health---ABH-OH_R1040915-1","x-work-arrangement":"remote","x-experience-level":"senior","x-job-type":"full-time","x-salary-range":"$174,070.00 - $374,920.00","x-skills-required":["Psychiatry","Utilization Management","Medical Leadership","Clinical Quality Improvement"],"x-skills-preferred":["Child/Adolescent Psychiatry","Managed Care Experience","Physician Advisor Experience"],"x-benefits":["pension","health_insurance","dental","paid_leave","bonus","equity"],"x-licences":[],"x-visa-sponsorship":"unknown","x-visa-sponsorship-text":null,"x-work-authorisation":"unknown","x-work-authorisation-text":null,"datePosted":"2026-11-02T00:00:00.000Z","jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Work from hom, OH"}},"jobLocationType":"TELECOMMUTE","employmentType":"FULL_TIME","occupationalCategory":"Healthcare","industry":"Healthcare","skills":"Psychiatry, Utilization Management, Medical Leadership, Clinical Quality Improvement, Child/Adolescent Psychiatry, Managed Care Experience, Physician Advisor Experience","baseSalary":{"@type":"MonetaryAmount","currency":"USD","value":{"@type":"QuantitativeValue","minValue":174070,"maxValue":374920,"unitText":"YEAR"}}},{"@context":"https://schema.org","@type":"JobPosting","identifier":{"@type":"PropertyValue","name":"YubHub","value":"job_89526e55-391"},"title":"Medical Director (Spine)","description":"<p>We&#39;re building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.</p>\n<p>At CVS Health®, you&#39;ll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.</p>\n<p><strong>This role requires Board Certification in Orthopedic Spine OR Neurosurgery.</strong></p>\n<p>The starting base salary for this role is $300K.</p>\n<p>As a Medical Director (Spine), you will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.</p>\n<p>Your responsibilities will include:</p>\n<ul>\n<li>Expanding Aetna&#39;s medical management programs to address member needs across the continuum of care.</li>\n<li>Supporting the Medical Management staff to ensure timely and consistent responses to members and providers.</li>\n<li>Leading all aspects of utilization review/quality assurance, directing case management.</li>\n<li>Providing clinical expertise and business direction in support of medical management programs through participation in clinical team activities.</li>\n<li>Acting as a lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.</li>\n<li>Conducting predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer-based applications.</li>\n</ul>\n<p><strong>Required Qualifications:</strong></p>\n<ul>\n<li>2 or more years of experience in Health Care Delivery System, e.g., Clinical Practice and Health Care Industry.</li>\n<li>Active and current state medical license without encumbrances.</li>\n<li>M.D. or D.O., Board Certification in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care experience specifically.</li>\n</ul>\n<p><strong>Preferred Qualifications:</strong></p>\n<ul>\n<li>Previous healthcare insurance experience.</li>\n</ul>\n<p><strong>Benefits:</strong> This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.</p>\n<p>The typical pay range for this role is: $174,070.00 - $374,920.00.</p>\n<p style=\"margin-top:24px;font-size:13px;color:#666;\">Job Data by <a href=\"https://yubhub.co\">YubHub</a>.</p>","url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Work-from-home/Medical-Director--Spine_R0811468","directApply":true,"hiringOrganization":{"@type":"Organization","name":"Aetna, a CVS Health Company","sameAs":"https://cvshealth.com","logo":"https://logos.yubhub.co/cvshealth.com.png"},"x-apply-url":"https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Work-from-home/Medical-Director--Spine_R0811468","x-work-arrangement":"remote","x-experience-level":"senior","x-job-type":"full-time","x-salary-range":"$174,070.00 - $374,920.00","x-skills-required":["Orthopedic Spine","Neurosurgery","Health Care Delivery System","Clinical Practice"],"x-skills-preferred":["Previous healthcare insurance experience"],"x-benefits":["pension","health_insurance","dental","paid_leave","bonus","equity"],"x-licences":[],"x-visa-sponsorship":"unknown","x-visa-sponsorship-text":null,"x-work-authorisation":"unknown","x-work-authorisation-text":null,"datePosted":"2026-10-22T00:00:00.000Z","jobLocationType":"TELECOMMUTE","employmentType":"FULL_TIME","occupationalCategory":"Healthcare","industry":"Healthcare","skills":"Orthopedic Spine, Neurosurgery, Health Care Delivery System, Clinical Practice, Previous healthcare insurance experience","baseSalary":{"@type":"MonetaryAmount","currency":"USD","value":{"@type":"QuantitativeValue","minValue":174070,"maxValue":374920,"unitText":"YEAR"}}},{"@context":"https://schema.org","@type":"JobPosting","identifier":{"@type":"PropertyValue","name":"YubHub","value":"job_a2fa763f-f88"},"title":"Medical Director","description":"<p>We&#39;re building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.</p>\n<p>Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognises physicians for their clinical quality and effective use of health care resources.</p>\n<p><strong>Job Details:</strong></p>\n<p>This is a remote-based (work at home) role based anywhere in the US.</p>\n<p><strong>Responsibilities:</strong></p>\n<ul>\n<li>Direct daily work on Part C appeals (both provider and member/non-participating providers)</li>\n<li>Provide direct support to appeal nurses; supervision and participation in the Second Look Review (SLR) process</li>\n<li>Provide after-hours and weekend coverage on a rotational basis to support 24/7 appeals work</li>\n<li>IRE monitoring and tracking and Utilisation Management Strategy support</li>\n<li>Collaborative work with Medicare Quality and Compliance on an ongoing basis</li>\n<li>Develop subject matter expertise on Medicare policy for the enterprise</li>\n<li>Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilisation Management Staff</li>\n<li>Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency</li>\n</ul>\n<p><strong>Requirements:</strong></p>\n<ul>\n<li>Two (2) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry</li>\n<li>Medical Licence (MD) or (DO)</li>\n<li>An Active state medical licence without encumbrances</li>\n<li>Board Certified in ABMS or AOA Recognised Specialty</li>\n</ul>\n<p><strong>Preferred Qualifications:</strong></p>\n<ul>\n<li>Medical Management - Medicare Complaints, Grievance &amp; Appeals experience</li>\n<li>Health Plan Experience Highly Preferred</li>\n</ul>\n<p><strong>Education:</strong></p>\n<ul>\n<li>MD or DO</li>\n</ul>\n<p><strong>Pay Range:</strong> $174,070.00 - $374,920.00</p>\n<p><strong>Benefits:</strong> We offer a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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