Medical Director-reputed company (ABH-WV)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: reputed company to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this opportunity with reputed company, a reputed company company! reputed company operates reputed company managed care plans in multiple states: Arizona, California, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, reputed company, Ohio, Oklahoma, Pennsylvania, Texas, Virginia and reputed company Virginia. This supports the reputed company reputed company of reputed company Virginia primarily This Medical Director role will be a "Work from Home" position primarily supporting the reputed company reputed company Virginia plan, and the Southeast Region (FL, KY and LA). The Medical Director 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 reputed company to precertification, reputed company review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and precertification as well as reputed company review. Cases could focus on inpatient or outpatient, acute and post-acute as well as peer to peer calls and first level appeals. The Medical Director participates in a rotating on call schedule to reputed company weekend and holiday coverage. Required Qualifications: - Five or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. - Active and reputed company reputed company Virginia state medical license without encumbrances as well as the ability to obtain Florida, Louisiana and Kentucky licenses. - M.D. or D.O., reputed company 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 Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus + Preferred Qualifications: -Health plan/payor Utilization Management / Review experience. -Electronic medical systems/record experience. -Managed Care experience. -reputed company experience. Education M.D. or D.O., Pay reputed company The typical pay reputed company for this role is: $174,070.00 - $374,920.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people 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 reputed company 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 reputed company 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 reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 03/31/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, reputed company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job