About this role
Resources
Home
Jobs
Recommended Jobs
Salaries
Salary Map
Back to resources
I'm Interested
CVS Health
Remote Based Medical Director- Medicare Appeals
Connecticut
full-time
Non clinical
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 Medicare Appeals:
- Direct daily work on part C appeals (both provider and member/nonparticipating providers)
- Provide direct support to appeal nurses; supervision and participation in the Second Look Review (SLR) process
- Provide after hours and weekend coverage on a rotational basis 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 basis
- Develop subject matter expertise on Medicare policy for the enterprise
- Provide 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
-
Click here
-
for more details about this position.
-
Compensation Details
-
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.
-
Posted September 29, 2026