Medical Director - Medicaid Appeals

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) based anywhere in the US.**

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  You will support the Medical Management staff ensuring timely and consistent responses to member and provider appeals, state fair hearings, and escalated complaints

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  As a Medical Director you will focus primarily on member and provider appeals related to medical necessity

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  You will provide clinical expertise and consultation to the Medicaid grievance and appeals team

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  You will chair/co-chair Medicaid appeals committee meetings.

• 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

• 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

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

The typical pay range for this role is: