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CVS HealthPosted 10/19/2026full-timeRemote • Louisiana • United StatesLead💰 $174,070 - $374,920 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management, including prior authorization, medical necessity reviews, and peer-to-peer consultations. Holds an active medical license and board certification in a recognized specialty, with extensive clinical practice experience in managed care settings.
Highest-signal resume keywords
Active Medical LicenseM.D. or D.O. DegreeBoard Certification in Family Medicine, Emergency Medicine, or Internal Medicine-PediatricsUtilization Management Experience5+ Years of Clinical Practice Experience
About the role
Key responsibilities & impact- Support Aetna Better Health of Louisiana and other health plans as needed through centralized Medical Management
- Partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers
- Conduct utilization management and medical necessity reviews
- Make prior authorization and precertification determinations
- Perform concurrent reviews for inpatient and outpatient services
- Conduct acute and post-acute care reviews
- Participate in peer-to-peer consultations with treating providers
- Conduct pharmacy reviews and first-level appeal determinations
- Collaborate with multidisciplinary clinical and operational teams
- Participate in a rotating on-call schedule, including weekend and holiday coverage
Requirements
What you’ll need- Must have an active, unrestricted medical license
- Ability to be licensed in Florida and Kentucky
- M.D. or D.O. degree
- Current, active Board Certification in an ABMS- or AOA-recognized specialty
- 5+ years of post-residency clinical practice and direct patient care experience
- Active, unrestricted Louisiana medical license preferred
- Board certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics preferred
- Prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor capacity preferred
- Medicaid and managed care experience preferred
- Experience with medical necessity review, prior authorization, concurrent review, appeals, and peer-to-peer consultation preferred
- Experience using electronic health records and other clinical documentation systems preferred
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program
- Equity award program
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ManagementMedical Necessity ReviewPrior AuthorizationConcurrent ReviewPeer-to-Peer ConsultationAcute Care ReviewPost-Acute Care ReviewPharmacy ReviewFirst-Level Appeal DeterminationDirect Patient Care
Soft Skills
CollaborationCommunication
Tools & Technologies
Electronic Health RecordsClinical Documentation Systems
Certifications & Qualifications
Board Certification in an ABMS- or AOA-Recognized Specialty
Industry Keywords
MedicaidManaged CareHealth PlanIndependent Review OrganizationPhysician Advisor