[Hiring] Medical Director - Medicaid Appeals @CVS Health

Role Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

This role primarily supports the Southeast Region (Florida, Kentucky, Louisiana & West Virginia). This is a remote based (work at home) position based anywhere in the US.

• Responsibilities of this Medical Director role are related to Medicaid Appeals.
• You will support the Medical Management staff ensuring timely and consistent responses to member and provider appeals, state fair hearings, and escalated complaints.
• As a Medical Director you will focus primarily on member and provider appeals related to medical necessity.
• You will provide clinical expertise and consultation to the Medicaid grievance and appeals team.
• You will chair/co-chair Medicaid appeals committee meetings.

Qualifications

• Five (5) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry.
• An Active state medical license without encumbrances as well as the ability to obtain FL, KY, LA & WV licensure.
• Board Certified in ABMS Recognized Specialty.

Requirements

• Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics specialty preferred.
• Previous experience in Medicaid Policy and the use of Dynamo Appeals and Grievances (DAG).
• Prior managed care experience in utilization management.
• Prior experience in appeals.

Education

• M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.

Benefits

• The typical pay range for this role is: $174,070.00 - $374,920.00.
• This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
• This position also includes an award target in the company’s equity award program.
• This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.