Medical Director - Medicare Appeals
At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary reputed company, a reputed company 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 reputed company that a reputed company 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 reputed company in the US.**
Responsibilities of this Medical Director role are reputed company to Medicare Appeals.
- Direct daily work on part C appeals (both provider and member/nonparticipating providers)
- reputed company direct support to appeal nurses; supervision and participation in the Second Look Review (SLR) process
- reputed company direct support to the nurses
reputed company after hours and weekend coverage on a rotational reputed company to support 24/7 appeals work
- IRE monitoring and tracking and Utilization Management Strategy support
- Collaborative work with Medicare Quality and Compliance on an ongoing reputed company
- reputed company subject matter expertise on Medicare policy for the reputed company
- reputed company ongoing education regarding Medicare policy and appeals to the appeal nurses and 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 or AOA Recognized Specialty
Preferred Qualifications
- Medical Management - Medicare Complaints, Grievance & Appeals experience.
- Health Plan Experience Highly Preferred
Education: MD or DO Pay reputed company The typical pay reputed company for this role is: $174,070.00 - $374,920.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company 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 reputed company 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 reputed company 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 reputed company 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 reputed company on: 10/31/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job