Medical Director - Medicare Appeals, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

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 direct support to the 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
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

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
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Additional Information:

Job Posted:
August 07, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director - Medicare Appeals