Medical Director – Medicare Appeals

CVS Health

. Direct daily work on Part C appeals, including provider and member/nonparticipating provider appeals .

Posted 10/16/2026full-timeRemote • Connecticut • United StatesLead💰 $174,070 - $374,920 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare policy and appeals processes, with a strong focus on improving team efficiency and clinical consistency. Holds a valid medical license and board certification, ensuring compliance and quality in health care delivery.

Highest-signal resume keywords

Medical License (MD Or DO)Board Certified In ABMS Or AOA Recognized SpecialtyMedicare Complaints, Grievance & Appeals ExperienceHealth Plan ExperienceHealth Care Delivery System Experience

ATS Keywords

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Applicant Tracking System Keywords

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Industry Keywords

Part C AppealsSecond Look Review (SLR)Utilization Management StrategyMedicare Quality And ComplianceClinical PracticeHealth Care IndustryAppeal NursesOngoing EducationAppeals Team EfficiencyClinical Consistency

About the role

Key responsibilities & impact

Direct daily work on Part C appeals, including provider and member/nonparticipating provider appeals
Provide direct support to appeal nurses
Supervise and participate in the Second Look Review (SLR) process
Provide after-hours and weekend coverage on a rotational basis to support 24/7 appeals work
Monitor and track IRE activity and support Utilization Management Strategy
Collaborate with Medicare Quality and Compliance
Develop subject matter expertise on Medicare policy for the enterprise
Provide ongoing education on Medicare policy and appeals to appeal nurses and territory Utilization Management staff
Participate in initiatives to improve appeals team efficiency and clinical consistency

Requirements

What you’ll need

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
MD or DO
Medical Management - Medicare Complaints, Grievance & Appeals experience preferred
Health Plan Experience highly preferred

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
Award target in the company’s equity award program
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being