[Hiring] Medical Director - Medicare Appeals @CVS Health

Role Description

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 is a remote based (work at home) based anywhere in the US.

Responsibilities

• 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 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

Qualifications

• 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

Requirements

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

Education

• MD or DO

Pay Range

The typical pay range for this role is: $174,070.00 - $374,920.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. 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.

Benefits

• Comprehensive and competitive mix of pay and benefits
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.