Medical Director - Medicaid Appeals
CVS Health
•$174,070 - $374,920•Remote
About The Position
Aetna, a CVS Health Company, is a national insurer with a unique opportunity to help transform health care. They believe in a more transparent and consumer-focused care system that 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) and is a remote-based position anywhere in the US.
Requirements
- 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.
- M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
Nice To Haves
- Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics specialty.
- 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.
Responsibilities
- Support the Medical Management staff ensuring timely and consistent responses to member and provider appeals, state fair hearings, and escalated complaints.
- Focus primarily on member and provider appeals related to medical necessity.
- Provide clinical expertise and consultation to the Medicaid grievance and appeals team.
- Chair/co-chair Medicaid appeals committee meetings.
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
