CVS Health
Medical Director – Medicare Appeals
CVS Health
Location:
Remote (work at home) — anywhere in the US.
Position Summary Aetna, a CVS Health Company, leverages decades of experience to transform health care. In this role you will serve as a Medical Director focused on Medicare Appeals, providing expertise and leadership to ensure high‑quality member and provider outcomes.
Responsibilities
Direct daily work on Part C appeals (provider and member/nonparticipating providers).
Provide direct support to appeal nurses; supervise and participate in the Second Look Review (SLR) process.
Offer after‑hours and weekend coverage on a rotational basis to support 24/7 appeals work.
Monitor IRE and track utilization management strategy support.
Collaborate with Medicare Quality and Compliance on an ongoing basis.
Develop subject matter expertise on Medicare policy for the enterprise.
Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory utilization management staff.
Participate in initiatives to improve appeals team efficiency and clinical consistency.
Required Qualifications
Two or more years of experience in a Health Care Delivery System (e.g., Clinical Practice or Health Care Industry).
Medical License (MD or DO).
Active state medical license without encumbrances.
Board Certified in ABMS or AOA recognized specialty.
Preferred Qualifications
Experience in Medical Management – Medicare Complaints, Grievance & Appeals.
Health Plan experience.
Education MD or DO.
Pay Range $174,070.00 – $374,920.00 (base hourly rate or base annual full‑time salary). The actual offer will depend on experience, education, geography and other factors. The role is also eligible for bonuses, commissions or other incentive programs and includes an award target in the company’s equity award program.
Benefits
Affordable medical plan options, 401(k) plan with matching contributions, employee stock purchase plan.
No‑cost programs: wellness screenings, tobacco cessation, weight management, confidential counseling, financial coaching.
Benefit solutions addressing diverse needs: paid time off, flexible schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and more (depending on eligibility).
For more information, visit https://jobs.cvshealth.com/us/en/benefits
EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
CVS Health
Location:
Remote (work at home) — anywhere in the US.
Position Summary Aetna, a CVS Health Company, leverages decades of experience to transform health care. In this role you will serve as a Medical Director focused on Medicare Appeals, providing expertise and leadership to ensure high‑quality member and provider outcomes.
Responsibilities
Direct daily work on Part C appeals (provider and member/nonparticipating providers).
Provide direct support to appeal nurses; supervise and participate in the Second Look Review (SLR) process.
Offer after‑hours and weekend coverage on a rotational basis to support 24/7 appeals work.
Monitor IRE and track utilization management strategy support.
Collaborate with Medicare Quality and Compliance on an ongoing basis.
Develop subject matter expertise on Medicare policy for the enterprise.
Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory utilization management staff.
Participate in initiatives to improve appeals team efficiency and clinical consistency.
Required Qualifications
Two or more years of experience in a Health Care Delivery System (e.g., Clinical Practice or Health Care Industry).
Medical License (MD or DO).
Active state medical license without encumbrances.
Board Certified in ABMS or AOA recognized specialty.
Preferred Qualifications
Experience in Medical Management – Medicare Complaints, Grievance & Appeals.
Health Plan experience.
Education MD or DO.
Pay Range $174,070.00 – $374,920.00 (base hourly rate or base annual full‑time salary). The actual offer will depend on experience, education, geography and other factors. The role is also eligible for bonuses, commissions or other incentive programs and includes an award target in the company’s equity award program.
Benefits
Affordable medical plan options, 401(k) plan with matching contributions, employee stock purchase plan.
No‑cost programs: wellness screenings, tobacco cessation, weight management, confidential counseling, financial coaching.
Benefit solutions addressing diverse needs: paid time off, flexible schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and more (depending on eligibility).
For more information, visit https://jobs.cvshealth.com/us/en/benefits
EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr