Become a part of our caring community The Field Service Coordinator (Care Coach 1) assesses and evaluates member's needs and requirements. This is done to achieve and/or maintain optimal wellness state by guiding members/families toward resources appropriate for their care and wellbeing. The Service Coordinator work assignments are often straightforward and of moderate complexity. Your role will involve meeting members in their location, spending quality time assessing their needs and barriers and then connecting our members with quality services to promote their ultimate well-being and guide health outcomes. Responsibilities include: Administer ongoing long-term services and support (LTSS) related assessments through person-centered thinking approaches. Contacts members both telephonically and/or in-person to establish goals and priorities. This involves evaluating resources, developing a plan of care, and identifying LTSS providers and community partnerships. The goal is to provide a combination of services and supports that best meet the needs and goals of the member and caregiver through person-centered thinking approaches. Development and modification of Service Plan and involve applicable members of the care team in care planning (Informal caregiver coach, PCP) Support members through navigation of their LTSS and related environmental and social needs Use available information about member to prevent the need for administration of duplicative assessments. Focus on supporting members or caregivers in accessing long-term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs. Assist members in maintaining Medicaid eligibility Collaborate with Medical Director/Geriatrician/Care Coordinator as deemed necessary to ensure cohesive, holist
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Role overview
Job description
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate 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:
Ready to take your Medical Director career to the next level with a Fortune 6 company?
Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country.
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.
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.
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:
- Utilization Management and medical necessity reviews
- Prior authorization and precertification determinations
- Concurrent review for inpatient and outpatient services
- Acute and post-acute care reviews
- Peer-to-peer consultations with treating providers
- Pharmacy reviews and first-level appeal determinations
- Collaboration with multidisciplinary clinical and operational teams
The Medical Director also participates in a rotating on-call schedule that includes weekend and holiday coverage.
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.
Required Qualifications:
- Active, unrestricted Louisiana medical license.
- The ability to be licensed in Florida and Kentucky
- M.D. or D.O. degree with current, active Board Certification in an ABMS- or AOA-recognized specialty.
- 5+ years of post-residency clinical practice and direct patient care experience.
Preferred Qualifications:
- Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics.
- Prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor capacity.
- Medicaid and managed care experience.
- Experience with medical necessity review, prior authorization, concurrent review, appeals, and peer-to-peer consultation.
- Experience using electronic health records and other clinical documentation systems.
Education:
MD or DO
Pay Range
The typical pay range for this role is:
$174,070.00 - $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.
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
What they are looking for
Skills & requirements
Qualification
Active, unrestricted Louisiana medical license; M.D. or D.O. degree with current, active Board Certification in an ABMS- or AOA-recognized specialty; Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics
Hiring company
Cvshealth
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