Medical Director - Medicare Appeals, CVS Health

Medical Director - Medicare Appeals

CVS Health

Location:
United States, Work at Home

Category:
-

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

Medical Director role at Aetna, a CVS Health Company, focused on Medicare Appeals. This is a remote position based anywhere in the US, responsible for transforming health care through a more transparent and consumer-focused system that recognizes physicians for clinical quality and effective use of health care resources.

Job Responsibility:

Direct daily work on part C appeals (both provider and member/nonparticipating providers)
Provide direct support to appeal nurses and dedicated Medicare part D pharmacists
supervision and participation in the Second Look Review (SLR) process
Provide direct support to the Quality Review nurses
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
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

Requirements:

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

Nice to have:

Medical Management - Medicare Complaints, Grievance & Appeals experience
Health Plan Experience Highly Preferred

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
employee stock purchase plan
No-cost wellness screenings
tobacco cessation and weight management programs
confidential counseling and 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:
October 25, 2025

Expiration:
October 31, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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