Medical Director - Medicare Appeals

American College of Health Care Administrators; Hartford (CT); Remote; USD 174,000 - 375,000; Full time

Job summary

CVS Health seeks a Medical Director for remote work, focusing on Medicare Part C appeals. The role involves supporting appeals nurses and collaborating on compliance initiatives, requiring an active medical license and relevant healthcare experience. This position offers a competitive salary and comprehensive benefits.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and counseling programs

Flexible work schedules

Tuition assistance

Qualifications

• Two or more years of experience in a Health Care Delivery System.
• Active state medical license without encumbrances.
• Medical Management experience preferred.

Responsibilities

• Support Medicare appeal nurses with compliance and education.
• Provide after hours and weekend coverage for appeals.
• Participate in initiatives to improve overall efficiency.

Skills

Health Care Delivery System experience

Clinical Practice

Collaboration

Education

Medical License (MD) or (DO)

Board Certified in ABMS Recognized Specialty

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) based anywhere in the US.**

Responsibilities of this Medical Director role are related to Part C Medicare Appeals. This position is primary on the non-regulated appeals team, however the expectation is to cross train for regulated appeals.

* Provide support to Medicare appeal nurses

* Provide after hours and weekend coverage on a rotational basis to support 72 hour turn around time

* Collaborative work with Medicare Quality and Compliance on an ongoing basis

* Provide ongoing education/ subject matter expertise regarding Medicare policy and appeals to the territory Utilization Management staff

* Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency

Required Qualifications
* Two (2) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry

* Medical License (MD) or (DO)

* An Active state medical license without encumbrances

* Board Certified in ABMS Recognized Specialty

Preferred Qualifications
* Medical Management - Medicare Complaints, Grievance & Appeals experience.

* 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 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: 06/27/2025

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