Medical Director - Medicare Appeals
CVS Health•Work At Home-Connecticut, CT
•$174,070 - $374,920•Remote
About The Position
Aetna, a CVS Health Company, is one of the oldest and largest national insurers. This is a remote-based position (work at home) anywhere in the US. The company aims to transform healthcare by making it more transparent and consumer-focused, recognizing physicians for their clinical quality and effective use of health care resources.
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 Haves
- Medical Management - Medicare Complaints, Grievance & Appeals experience.
- Health Plan Experience Highly Preferred
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
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Ph.D. or professional degree
