Remote Medical Director — Medicaid Appeals

Colorado Psychiatric; Colorado; Remote; USD 174,000 - 375,000; Full time

Benefits offered by this job

Medical benefits

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health, a Fortune 6 company, is seeking a Medical Director to support Medicaid appeals nationwide, primarily for the Southeast Region. This remote position requires an active medical license and board certification.

The role involves leading appeals processes, clinical consultation, and chairing Medicaid appeals committee meetings. The ideal candidate has 5+ years in health care delivery, licensure in multiple states (FL, KY, LA, WV), and a strong background in medical necessity reviews.

Qualifications

• Five+ years experience in a health care delivery system or similar.
• Active state medical license with no encumbrances; ability to obtain FL, KY, LA & WV licensure.
• Board certification in an ABMS recognized specialty.

Responsibilities

• Support Medical Management staff ensuring timely responses to member and provider appeals, state fair hearings, and escalated complaints.
• Focus on medical necessity related Medicaid appeals.
• Provide clinical expertise and consultation to the Medicaid grievance and appeals team.
• Chair or co-chair Medicaid appeals committee meetings.

Skills

Health care delivery systems

Active medical license

Board certification

Education

MD/DO

Job description

CVS Health, a Fortune 6 company, is seeking a Medical Director to support Medicaid appeals nationwide, primarily for the Southeast Region. This remote position requires an active medical license and board certification.

The role involves leading appeals processes, clinical consultation, and chairing Medicaid appeals committee meetings. The ideal candidate has 5+ years in health care delivery, licensure in multiple states (FL, KY, LA, WV), and a strong background in medical necessity reviews.