Medical Director - Medicare Appeals, CVS Health

CVS Health

Location:
United States

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

Medical Director role providing oversight for medical policy implementation and supporting Medical Management staff. Focuses on reviewing appeal cases for denied medical services including First Level Appeals, Second Level Appeals, Expedited Appeals, and Appeal Hearings.

Job Responsibility:

Provide oversight for medical policy implementation
Support Medical Management staff ensuring timely and consistent responses to members and providers
Review appeal cases for denied medical services (First Level Appeals/Second Level Appeals/Expedited Appeals/Appeal Hearings)
Provide clinical, coding, and reimbursement expertise
Direct case management when necessary
Act as business and clinical liaison to network providers and facilities

Requirements:

Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry
Prior UM (Utilization Management) experience
Active and current state medical license without encumbrances
M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience

Nice to have:

Internal Medicine background
Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 28, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director - Medicare Appeals