Medical Director - Medicaid; ABH LA

Position Summary

Ready to take your Medical Director skills to the next level with a Fortune 6 company? This opportunity is with Aetna, a CVS Health company. Aetna operates Medicaid managed care plans in multiple states including Louisiana, Florida, Kentucky, Missouri, West Virginia, and others. The Medical Director will be a "Work from Home" position primarily supporting Aetna Better Health of Louisiana and the Southeast Region (FL, KY, WV).

The role 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 related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and precertification as well as concurrent review. Cases may focus on inpatient or outpatient, acute and post‑acute scenarios, peer‑to‑peer calls, and first‑level appeals. The Medical Director participates in a rotating on‑call schedule to provide weekend and holiday coverage.

• Five or more years of experience in Health Care Delivery System such as Clinical Practice and Health Care Industry.
• Active and current Louisiana state medical license without encumbrances and the ability to obtain Florida, Kentucky, and West Virginia licenses.
• M.D. or D.O., current 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.
• Prior UM experience working at a Health Plan / Insurer or as a Physician Advisor or with an Independent Review Organization.

• Health plan/payor Utilization Management / Review experience.
• Electronic medical systems/record experience.
• Managed Care experience.
• Medicaid experience.

• M.D. or D.O., Board Certification in ABMS or AOA recognized specialty including post‑graduate direct patient care experience.

The Typical Pay Range For This Role Is
$ - $
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.

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 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.

For more information, visit

We anticipate the application window for this opening will close on: 02/13/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Director

Full‑time

Health Care Provider

Hospitals and Health Care