Medical Director Medicaid in United States

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-c

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

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 Aetna Better Health is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna® Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members. Aetna Better Health of Maryland is seeking an experience leader with vast operational knowledge of Medicaid for its state-wide managed Medicaid business in the role of Chief Operations Officer (COO). The COO role will be strategic and committed to developing colleagues as well as relentlessly pursuing change that is best for the organization and its customers. The COO role will collaborate with the CEO to develop the strategic vision of the Health Plan, policies & procedures, and operational objectives including leading RFP readiness efforts. The COO will oversee high level strategic and operational activities of various plan functional areas which include traditional service operations (Claims, Provider Services, Information Technology, Grievance & Appeals and Member Services) as well as Medical Management (Quality, Netw

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

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. Job Purpose and Summary: Join a mission-driven organization at a transformative moment in employer-sponsored health care. As Executive Medical Director, Clinical Business Solutions at Aetna, a CVS Health company, you will lead the clinical team that serves as the clinical voice to our Commercial plan sponsors, prospects, and their advisors, demonstrating how Aetna’s clinical capabilities reduce cost, improve population health, and strengthen the member and provider experience. Reporting directly to the Vice President, Chief Medical Officer, Commercial & Innovation, you will direct a national team of clinicians (MD, RN, NP) providing clinical support to Aetna’s National Accounts, Large Group, and Public & Labor businesses, in close partnership with Field and Account teams. You will lead and continuously improve the operations of the team to raise the level and quality of clinical support delivered to the Field, while sharing directly in its external work — including personally cultivating and holding relationships with key brokers, consultants, and plan sponsors. The role is deliberately bidirectional. You will bring the voice of the customer and the producer community back into the organization, partnering with Clinical Operations, Medical Affairs, Commercial Product, and others to ensure our clinical offerings reflect what the market requires. <p

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. Senior Medical Director, Clinical Informatics Position Summary The Senior Medical Director for Clinical Informatics and Healthcare Delivery (HCD) Technology Product serves as the senior physician leader across healthcare delivery technical domains, providing clinical insight and technical expertise to drive end-to-end technology execution and ensure that Epic-enabled solutions advance core business outcomes. This role is the clinical expert and trusted physician advisor for teams across HCD technology, driving effective enterprise governance, improving clinician experience, enhancing patient outcomes, and supporting organizational strategic priorities. The Senior Medical Director will also serve as the product leader for two core HCD technology domains - Center Operations and Quality/Stars. The Senior Medical Director brings hands-on clinical and Epic build expertise, partners closely with operational and technical leadership across the enterprise to align the Epic roadmap with organizational strategy, has excellent clinical judgement and keeps patient experience, safety, and outcomes at the center of everything we do, and represents the clinical voice in enterprise governance, escalation, and innovation efforts. Key Responsibilities Clinical Product & Technology Leadership Serve as the senior product leader across Clinic Operations and Quality

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. The purpose of the Center Medical Director role is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients happy, healthy and out of the hospital. The Medical Director will practice primary care in our clinics alongside their provider colleagues at 80% clinical time and 20% administrative time. The CMD will have mission-critical leadership responsibilities, which include setting an example for how thoughtful primary care is practiced, serving as a formal mentor, coach, and advisor to providers in clinics, and participating in critical organizational-wide strategic initiatives. Core Responsibilities: The Center Medical Director is the medical leader for his/her center. In this role the CMD will have the following responsibilities: Support of Organizational Strategy Work in tight collaboration with the Practice Manager and Outreach Manager/Director to achieve our organizational objectives: Best Care Anywhere Unmatched Patient Experience Exceptional Growth Great Place to Work and Leader in DE&I Drive implementation of strategic initiatives. Follow direction from regional leadership (regional medical director or senior medical director) in collaboration with CMDs in the region to implement regional priorities and reach regional objectives.<br

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. Title: Center Medical Director Company: Oak Street Health Role Description: The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients happy, healthy and out of the hospital. The Medical Director will practice primary care in our clinics alongside their provider colleagues at 80% clinical time and 20% administrative time. The CMD will have mission-critical leadership responsibilities, which include setting an example for how thoughtful primary care is practiced, serving as a formal mentor, coach, and advisor to providers in Oak Street clinics, and participating in critical organizational-wide strategic initiatives. Core Responsibilities: The Center Medical Director is the medical leader for his/her OSH center. In this role the CMD will have the following responsibilities: Support of Organizational Strategy Work in tight collaboration with the Practice Manager and Outreach Manager/Director to achieve our organizational objectives: Best Care Anywhere Unmatched Patient Experience Exceptional Growth Great Place to Work and Leader in DE&I Drive implementation of OSH strategic initiatives. Follow direction

ROLE SUMMARY The Clinician Medical Monitor is accountable for providing medical and scientific expertise and oversight for Clinical Trials and serves as a single point of accountability for design, execution, monitoring, delivery and reporting of one or more clinical studies and to ensure patient safety. The clinician medical monitor may be required to design a development strategy for multiple protocols designed to obtain worldwide approval for a compound or group of compounds. In addition to study level activities, the clinician medical monitor may participate in standing committees, review compounds for potential in-licensing, including performance of due diligence reviews, and aid new business development on market opportunities and the target product profile. ROLE RESPONSIBILITIES Accountable for safety across the study Provide study team with medical advice for all medical issues during risk assessment and mitigation planning to enable quality, compliance and patient safety at the trial, site and patient level. Ensures development of and adherence to the Safety Surveillance Review Plan (SSRP). Consistent with the SSRP, performs and documents regular review of individual subject safety data, and performs review of cumulative safety data with the safety risk lead. As appropriate, the clinician medical monitor may delegate these responsibilities to the study clinician scientist identified in the SSRP. The specific components of safety data review are detailed in the appropriate SOPs and the “Safety Data Review Guide – for Clinicians.” Monitor study safety issues and provide input to serious adverse events (SAEs) reports. Provides appropriate medical context in terms of risk factors, medical history and other important medical factors required to put the SAE or AE into appropriate medical context required for benefit-risk assessm

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. Title: Primary Care Physician Company: Oak Street Health Address: 436 E Washington Blvd, Fort Wayne, IN 46802 Salary: $240,000- $270,000 **Wider range available depending on experience and location Schedule: Full-Time, Monday through Friday, 8:00 AM - 5:00 PM Role Description: The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based healthcare to local Medicare patient populations at our innovative network of neighborhood primary care centers. Our Primary Care Physicians operate at a single medical center supported by large care teams so our providers can focus on delivering a better quality of care, rather than a volume of services. Our value-based care model and competitive bonuses are structured to reward outcomes, drive low hospital admissions, deliver preventive medicine, and result in an unmatched patient experience. We’re looking for physicians who are intrinsically motivated to provide this kind of excellent care to older adults. New graduates are encouraged to apply. Highly qualified candidates may also be considered for a Center Medical Director position. Responsibilities: Assess and diagnose patients at our local clinics Oversee, direc

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. Title: Primary Care Physician Company: Oak Street Health Location: 951 N 6th St #221, Reading, PA 19601 Salary: $240,000 - $270,000 *Wider range available depending on experience and location Role Description: The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based healthcare to local Medicare patient populations at our innovative network of neighborhood primary care centers. Our Primary Care Physicians operate at a single medical center supported by large care teams so our providers can focus on delivering a better quality of care, rather than a volume of services. Our value-based care model and competitive bonuses are structured to reward outcomes, drive low hospital admissions, deliver preventive medicine, and result in an unmatched patient experience. We’re looking for physicians who are intrinsically motivated to provide this kind of excellent care to older adults. New graduates are encouraged to apply. Highly qualified candidates may also be considered for a Center Medical Director position. Responsibilities: Assess and diagnose patients at our local clinics Oversee, direct, and administer

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: Job Description Position Overview The Clinical Laboratory Scientist I performs laboratory analysis on clinical specimens using established laboratory procedures within the assigned department/laboratory. The Clinical Laboratory Scientist I duties will include, but are not limited to, processing of specimens, performance of moderate and highly complex analytical testing, establishing, performing, and documenting quality assurance, quality control, equipment maintenance, and accurately documenting all work performed under the direction of the Laboratory Medical Director. As a Clinical Laboratory Scientist I, you will recognize and resolve problems using good laboratory practices. Shift: Sat - Mon, 6p - 630a Essential Duties (include but are not limited): Perform moderate and highly complex laboratory tests, procedures, and analyses according to the laboratory’s standard operating procedures. Perform, review, and document laboratory quality control procedures. Operate, maintain, and troubleshoot laboratory equipment. Prepare reagents required for laboratory testing. Identify and troubleshoot basic problems that adversely affect test performance and/or laboratory operations. Achieve and maintain competency on laboratory tasks. Assist with mentoring new laboratory personnel on current and new procedures, as needed. </

What you’ll do Own and evolve the Quality Management System (QMS) to support a regulated medical device development program, including design controls and DHF maintenance. Establish and enforce requirements traceability: user needs → design requirements → verification/validation artifacts and change control. Define and run the program-level V&V strategy (verification, validation, and test coverage), including test plans, protocols, reports, and acceptance criteria. Drive risk management activities (e.g., DFMEA / PFMEA, hazard analyses) and ensure mitigations are reflected in requirements and verification. Lead document control: reviews, approvals, training, retention, and audit readiness. Partner with engineering to make quality “native” to the dev workflow (automated testing, release gates, software configuration management). Prepare the program for audits and inspections, including hands-on audit leadership. What we’re looking for Senior experience leading quality for complex hardware + software products in a regulated environment. Deep familiarity with design controls, DHF, document control, risk management, and verification planning. Strong systems thinking and the ability to translate ambiguous product intent into testable requirements. Comfortable collaborating directly with multidisciplinary engineering (recon/ML, embedded, mechanical, EE, cloud). Useful experience Regulated product quality leadership (ISO 13485 / 21 CFR 820 or equivalent), including audit readiness and FDA-facing work. eQMS + document control fluency (e.g., Greenlight Guru) that integrates cleanly with modern engineering workflows.

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. Executive Director, Technology Product Management – Medical Cost Initiatives Location: Remote Department: Healthcare Technology & Product Management Reports To: VP, Chief Health Informatics Officer (CHIO) - CVS Healthcare Delivery Role Overview As the Executive Director, Digital Product – Medical Cost Initiatives , you will lead the technology product strategy and execution for key medical cost portfolios for CVS Healthcare Delivery businesses. Core areas of focus are Care Transitions, Patient Segmentation, Chronic Condition Pathways, and Specialty Care Services. In this high-impact executive role, you will partner directly with clinical and business operational leaders to shape end-to-end technology pathways that support CVS Healthcare Delivery care models. You will lead a multidisciplinary team of product managers, Epic analysts, software engineers, data scientists, and UI/UX designers to translate clinical vision into scalable technology roadmaps that optimize patient outcomes and lower the total cost of care. The ideal candidate must have expertise with value-

We’re here for one reason and one reason only – to cure cancer. Every moment is dedicated to developing treatments and every action moves us one step closer to our goal. We’ve made incredible scientific breakthroughs and our pioneering personalized CAR T-cell therapies have changed the paradigm. But we're not finished yet. Join Kite, as we make even bigger advances in cancer therapies, and help shape where our business and medical science goes next. We believe every employee deserves a great leader. People Leaders are the cornerstone to the employee experience at Gilead and Kite. As a people leader now or in the future, you are the key driver in evolving our culture and creating an environment where every employee feels included, developed and empowered to fulfil their aspirations. Join Kite and help create more tomorrows. Job Description We are seeking a Medical Strategy professional to join the Global Medical Strategy team for Lymphoma and Leukemia. This role partners closely with the Global Medical Lymphoma/Leukemia lead to support the development and execution of medical strategy across the product lifecycle, including marketed products and pipeline indications. The position collaborates cross‑functionally with internal partners and external experts to ensure the generation and communication of scientific evidence that supports optimal patient outcomes in hematologic malignancies. An exciting opportunity has arisen to join the Global Medical Strategy Team for Lymphoma and Leukemia (LL). In this role, the right candidate will receive a great opportunity to be part of one of the recent most impactful medical advancements in patient care and an opportunity to work towards better outcomes for patients with hematological malignancies. <p