Remote Medical Director, Medicaid Appeals Leader

Tnafp; Tennessee; Remote; USD 174,000 - 375,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement plan

Job summary

CVS Health is seeking a Medical Director to lead Medicaid Appeals within the Southeast region, supporting timely responses and high-quality medical necessity determinations. This remote, nationwide role offers significant impact across Florida, Kentucky, Louisiana and West Virginia.

You will chair Medicaid appeals meetings, provide clinical expertise to the grievances and appeals team, and collaborate with Medical Management to drive compliant, patient-centered outcomes.

Qualifications

• Five or more years of experience in a Health Care Delivery System.
• Active state medical license without encumbrances and ability to obtain FL, KY, LA & WV licensure.
• Board Certified in ABMS Recognized Specialty.

Responsibilities

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

Skills

Clinical leadership

Regulatory knowledge

Medical expertise

Education

M.D. or D.O., ABMS/AOA board certification

Job description

CVS Health is seeking a Medical Director to lead Medicaid Appeals within the Southeast region, supporting timely responses and high-quality medical necessity determinations. This remote, nationwide role offers significant impact across Florida, Kentucky, Louisiana and West Virginia.

You will chair Medicaid appeals meetings, provide clinical expertise to the grievances and appeals team, and collaborate with Medical Management to drive compliant, patient-centered outcomes.