Medical Director - Medicare 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 ourselvesaccountable 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.Position SummaryAetna, 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 of this Medical Director role are related to Medicare Appeals:* Direct daily work on part C appeals (both provider and member/nonparticipating providers).* Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation in the Second Look Review (SLR) process* Provide direct support to the Quality Review nursesProvide after hours and weekend coverage on a rotational basis to support 24/7 appeals work* IRE monitoring and tracking and Utilization Management Strategy support* 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 consistencyRequired 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 SpecialtyPreferred Qualifications* Medical Management - Medicare Complaints, Grievance & Appeals experience.* Health Plan Experience Highly PreferredEducation* Medical License (MD) or (DO)Pay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00This 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.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.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visitWe anticipate the application window for this opening will close on: 03/31/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Created: 2026-03-06