[Remote] Medical Director - Medicaid (IL) at CVS Health

Illinois, United States

CVS Health Logo
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries

Skills

Key technologies and capabilities for this role

Utilization ManagementPrior AuthorizationMedical DirectorPatient CareIllinois Medical LicenseAppeals ReviewState Fair Hearings

Questions & Answers

Common questions about this position

What is the pay range for the Medical Director role?

The typical pay range for this role is $174,070.00 - $374,920.00, with the actual base salary depending on factors like experience, education, geography, and other relevant factors.

Is this a remote position?

Yes, this is a 'Work from Home' position primarily supporting the Aetna Illinois Medicaid plan, part of a centralized team for Illinois, Michigan, Kansas, and Oklahoma, with occasional support for other regions.

What are the required qualifications for this role?

Required qualifications include five or more years of direct patient care experience, an active Illinois state medical license without encumbrances, M.D. or D.O. with current board certification in an ABMS or AOA specialty, and board certification in Family Medicine or Internal Medicine/Pediatrics.

What is the team structure like for this position?

This role is part of a centralized UM team supporting Illinois, Michigan, Kansas, and Oklahoma, primarily focused on the Aetna Better Health Plan of Illinois, with a rotating on-call schedule for weekends and holidays.

What makes a strong candidate for this Medical Director position?

Strong candidates will have the required five years of direct patient care, Illinois medical license, M.D./D.O. with relevant board certifications, plus preferred experience in health plan/payor UM, managed care, and Medicaid.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees

Benefits

Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.
Increased consumer interest in wellness boosts demand for CVS's health-related products.
The trend towards value-based care aligns with CVS's integrated healthcare approach.

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