Medical Director - Medicare Grievances and Appeals Corporate
HumanaSalary not specified
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries
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 CVS Health bonus, commission or short-term incentive program, plus an award target in the company’s equity award program.
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, a Medical License (MD or DO), an active state medical license without encumbrances, and board certification in an ABMS or AOA recognized specialty.
What does the team structure look like for this Medical Director role?
The role involves direct support to appeal nurses, dedicated Medicare part D pharmacists, and Quality Review nurses, including supervision in the Second Look Review process, plus after-hours coverage on rotation.
What experience makes a strong candidate for this position?
Preferred qualifications include Medical Management experience in Medicare Complaints, Grievance & Appeals, and health plan experience, which are highly preferred on top of the required clinical background.
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
