Medical Director - Medicare Appeals

Medical Director – Medicare Appeals

Join to apply for the Medical Director – Medicare Appeals role at CVS Health

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.

Position Summary

Aetna, a CVS Health Company, is one of the oldest and largest national insurers and provides a unique opportunity to help transform health care. The role focuses on Medicare Appeals.

Key Details

Remote work (work at home) – based anywhere in the US.

Responsibilities

• Direct daily work on Part C appeals (provider and member / nonparticipating providers).
• Provide direct support to appeal nurses, supervise and participate 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.
• Collaborate 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 appeal nurses and territory Utilization Management Staff.
• Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency.

Required Qualifications

Preferred Qualifications

Education

MD or DO required.

Pay Range

The typical pay range for this role is $174,070.00 – $374,920.00. This range represents the base hourly rate or base annual full‑time salary. The actual base salary offer will depend on experience, education, geography and other factors. The position is eligible for a bonus, commission, short‑term incentive program and an equity award program.

Benefits

For more information, visit https : / / jobs.cvshealth.com / us / en / benefits

We anticipate the application window for this opening will close on : 11 / 28 / 2025.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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