Medical Director - Medicare Appeals

Hispanic Alliance for Career Enhancement; Hartford (CT); Remote; USD 174,000 - 375,000; Full time

Job summary

An established industry player is seeking a dedicated healthcare professional to support Medicare appeals. This remote position offers the chance to work collaboratively with a team focused on improving healthcare delivery. Responsibilities include providing support to appeal nurses, participating in initiatives to enhance team efficiency, and educating staff on Medicare policies. The role promises a competitive salary and a comprehensive benefits package, emphasizing the importance of employee wellness and professional growth. If you are passionate about transforming healthcare and making a meaningful impact, this opportunity is perfect for you.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Flexible work schedules

Tuition assistance

Qualifications

• 2+ years of experience in a Health Care Delivery System.
• Active state medical license without encumbrances.

Responsibilities

• Support Medicare appeal nurses and provide after-hours coverage.
• Collaborate with Medicare Quality and Compliance teams.

Skills

Health Care Delivery System experience

Medicare policy knowledge

Clinical Practice experience

Education

Medical License (MD)

Medical License (DO)

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

This is a remote based (work at home) position, based anywhere in the US.

Responsibilities

1. Provide support to Medicare appeal nurses.
2. Provide after hours and weekend coverage on a rotational basis to support 72 hour turn around time.
3. Collaborative work with Medicare Quality and Compliance on an ongoing basis.
4. Provide ongoing education/subject matter expertise regarding Medicare policy and appeals to the territory Utilization Management staff.
5. Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency.

Required Qualifications

1. Two (2) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry.
2. Medical License (MD) or (DO).
3. An Active state medical license without encumbrances.
4. Board Certified in ABMS Recognized Specialty.

Preferred Qualifications

1. Medical Management - Medicare Complaints, Grievance & Appeals experience.
2. Health Plan Experience Highly Preferred.

Education

1. Medical License (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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/16/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.