Medical Director - Pharmacy Appeals
HumanaSalary not specified
Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What is the pay range for the Medical Director - Medicare Appeals role?
The typical pay range is $174,070.00 - $374,920.00, depending on factors like experience, education, and geography. The position is also eligible for a bonus, commission, short-term incentive program, and equity award.
Is this Medical Director position remote?
Yes, this is a remote-based work-at-home position available anywhere in the US.
What are the required qualifications for this role?
Candidates need two or more years of experience in a Health Care Delivery System like clinical practice or health care industry, an active state medical license without encumbrances, and to be board certified in an ABMS or AOA recognized specialty. Education must be MD or DO.
What does the work involve for the Medical Director in Medicare Appeals?
Responsibilities include direct work on Part C appeals, supporting appeal nurses in the Second Look Review process, after-hours/weekend coverage on rotation, IRE monitoring, collaboration with Medicare Quality and Compliance, developing Medicare policy expertise, educating staff, and improving appeals efficiency.
What experience makes a strong candidate for this Medical Director position?
Health plan experience is highly preferred, along with medical management experience in Medicare complaints, grievances, and appeals.
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees
