Remote Medical Director - Medicaid Appeals & Leadership

CVS Health Corporation; Colorado; Hybrid; USD 174,000 - 375,000; Full time

Job summary

CVS Health, via Aetna, seeks a Medical Director to lead Medicaid Appeals in the Southeast region. This remote role supports the Medicaid grievances and appeals team, providing clinical guidance and ensuring timely responses to member and provider appeals, state fair hearings, and escalated complaints.

The ideal candidate will hold an MD or DO, be board certified, possess an active license with ability to obtain FL, KY, LA, and WV, and have 5+ years in a health care delivery system.

Qualifications

• Active state medical license without encumbrances and ability to obtain FL, KY, LA & WV licensure.
• Five+ years of experience in a healthcare delivery system.
• Board Certification in ABMS recognized specialty.

Responsibilities

• Support Medical Management ensuring timely 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 Practice

Medical Licensure

Board Certification

Education

MD/DO

Job description

CVS Health, via Aetna, seeks a Medical Director to lead Medicaid Appeals in the Southeast region. This remote role supports the Medicaid grievances and appeals team, providing clinical guidance and ensuring timely responses to member and provider appeals, state fair hearings, and escalated complaints.

The ideal candidate will hold an MD or DO, be board certified, possess an active license with ability to obtain FL, KY, LA, and WV, and have 5+ years in a health care delivery system.