CVS Health
Medical Director - Medicare Appeals
$174K–$375K
CT - Work from home · Remote · Director · Full-time · Posted Oct 30, 2026
- Experience
- Two or more years in a health care delivery system (e.g., clinical practice) or health care industry.
- Education
- MD or DO
About the job
Oversees Medicare Part C appeals, supports appeal nurses and review processes, and helps ensure consistent application of Medicare policy.
What you'll do
- Direct daily work on provider and member/nonparticipating-provider Part C appeals; support appeal nurses and participate in Second Look Review.
- Provide rotating after-hours and weekend coverage, and support IRE monitoring, tracking, and Utilization Management strategy.
- Collaborate with Medicare Quality and Compliance, educate staff on Medicare policy and appeals, and contribute to efficiency and clinical-consistency initiatives.
What they ask for
- Medical license (MD or DO), active and without encumbrances.
- Board certified in an ABMS- or AOA-recognized specialty.
Nice to have
- Medical Management experience with Medicare Complaints, Grievance & Appeals.
- Health Plan experience.
Pay
$174,070.00 - $374,920.00 USD base salary
Model-written summary · the original posting is authoritative