CVS Pharmacy, Inc.Hiring

Medical Director - Medicaid

  • USD 174,070 to 374,920 per year
  • Remote, United States
  • Full-time
  • Lead
  • Posted 9 days ago
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In one line

Senior medical role supporting Medicaid plans, ensuring clinical decisions align with policies; fully remote with some on-call duties.

About the role

This role involves partnering with medical management staff to oversee utilization reviews and prior authorizations, focusing on Medicaid members across several states.

At a glance

Pay
USD 174,070 to 374,920 per year
Remote scope
Remote, United States
Seniority
Lead
Employment
Full-time
Skills
Utilization Management, Medical necessity review, Peer-to-peer consultation
Posted
20 Oct 2026
Last checked
26 Oct 2026

What you will do

  • Lead utilization management and medical necessity reviews
  • Handle prior authorization and precertification decisions
  • Conduct concurrent reviews for inpatient and outpatient services
  • Manage acute and post-acute care reviews
  • Participate in peer-to-peer consultations with providers

What they look for

  • Active, unrestricted medical license
  • Ability to be licensed in Florida and Kentucky
  • MD or DO with current board certification
  • 5+ years post-residency clinical practice
  • Direct patient care experience

Benefits

  • Bonus, commission, or short-term incentive eligibility
  • Equity award program participation

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How to connect

Questions about this job

Is this a remote job, and where can I work from?

Yes, it is listed as remote, aimed at candidates in the United States.

What does this job pay?

The posting states USD 174,070 to 374,920 per year.

What experience is needed?

It is a lead role. The posting asks for: active, unrestricted medical license; ability to be licensed in Florida and Kentucky; MD or DO with current board certification. Skills it names include Utilization Management, Medical necessity review, Peer-to-peer consultation.

How do I apply with Keywordise AI?

Select Apply with Keywordise AI, sign up and upload your CV. Keywordise writes a CV and a cover letter for this job from your real experience and applies for you. The 7-day free trial needs no card.

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CVS Pharmacy, Inc.Remote, United States
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