Medical Director - Medicare Appeals

CVS Health; Hartford (CT); Remote; USD 174,000 - 375,000; Full time

Job summary

A leading health solutions company seeks a Medical Director for Medicare Appeals. This remote role involves supporting appeal processes, collaborating with teams, and improving operational efficiency. Ideal candidates have healthcare delivery experience and an active medical license.

Benefits

Medical Plans

401(k)

Stock Purchase Plans

Wellness Programs

Paid Time Off

Flexible Schedules

Family Leave

Qualifications

• Two or more years in a healthcare 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

Healthcare Delivery

Medicare Policy

Collaboration

Education

Medical License (MD)

Medical License (DO)

Job description

Join to apply for the Medical Director - Medicare Appeals role at CVS Health

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Join to apply for the Medical Director - Medicare Appeals role at CVS Health

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 anywhere in the US.**

Responsibilities of this Medical Director role are related to Part C Medicare Appeals. This position is primarily on the non-regulated appeals team, with cross-training for regulated appeals.

• Provide support to Medicare appeal nurses
• Provide after-hours and weekend coverage on a rotational basis to support 72-hour turnaround time
• Collaborate with Medicare Quality and Compliance teams regularly
• Provide ongoing education and expertise regarding Medicare policy and appeals to the Utilization Management staff
• Participate in initiatives to improve team efficiency and clinical consistency

Required Qualifications

• Two (2) or more years of experience in a healthcare delivery system, such as clinical practice or healthcare industry
• Medical License (MD) or (DO)
• Active state medical license without encumbrances
• Board Certified in ABMS Recognized Specialty

Preferred Qualifications

• Experience in Medical Management, Medicare Complaints, Grievance & Appeals
• Health Plan Experience highly preferred

Education

• Medical License (MD) or (DO)

Pay Range

The typical pay range for this role is $174,070.00 - $374,920.00

This range reflects base salary or hourly pay, with actual offers depending on experience, education, location, and other factors. The role is eligible for bonuses, incentives, and equity awards.

Our people fuel our future. We are committed to fostering a workplace where every colleague feels valued and belongs.

Great Benefits for Great People

We offer comprehensive pay and benefits, including medical plans, 401(k), stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, and more. For details, visit https://jobs.cvshealth.com/us/en/benefits

Application deadline: 06/27/2025

Qualified applicants with arrest or conviction records will be considered in accordance with laws.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care