Medical Director – Medicaid Appeals

Job not on LinkedIn

🕒 August 12

🌵 Arizona, Colorado, +24 more states – Remote

🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 37%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Support the Southeast Region, primarily Florida, Kentucky, Louisiana, and West Virginia • Support Medical Management staff by ensuring timely and consistent responses to member and provider appeals, state fair hearings, and escalated complaints • Focus on member and provider appeals related to medical necessity • Provide clinical expertise and consultation to the Medicaid grievance and appeals team • Chair or co-chair Medicaid appeals committee meetings

🎯 Requirements

• Five (5) or more years of experience in a health care delivery system, such as clinical practice or the health care industry • Active state medical license without encumbrances • Ability to obtain Florida, Kentucky, Louisiana, and West Virginia medical licensure • Board Certified in an ABMS Recognized Specialty • M.D. or D.O. • Board Certification in an ABMS or AOA recognized specialty • Post-graduate direct patient care experience • Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics specialty preferred • Previous experience in Medicaid Policy and use of Dynamo Appeals and Grievances (DAG) preferred • Prior managed care experience in utilization management preferred • Prior experience in appeals preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program • Equity award program