Medical Director – Medicare Appeals

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🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

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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

• Direct daily work on Part C appeals, including provider and member/nonparticipating provider appeals • Provide direct support to appeal nurses • Supervise and participate in the Second Look Review (SLR) process • Provide after-hours and weekend coverage on a rotational basis to support 24/7 appeals work • Monitor and track IRE activity and support Utilization Management Strategy • Collaborate with Medicare Quality and Compliance • Develop subject matter expertise on Medicare policy for the enterprise • Provide ongoing education on Medicare policy and appeals to appeal nurses and territory Utilization Management staff • Participate in initiatives to improve appeals team efficiency and clinical consistency

🎯 Requirements

• Two (2) or more years of experience in a Health Care Delivery System, such as Clinical Practice or Health Care Industry • Medical License (MD) or (DO) • An active state medical license without encumbrances • Board Certified in an ABMS or AOA Recognized Specialty • Medical Management – Medicare Complaints, Grievance & Appeals experience preferred • Health Plan Experience highly preferred • MD or DO

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being