Medical Director – Medicaid Appeals

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Assist the Medical Management team by providing timely and consistent responses to member and provider appeals, state fair hearings, and escalated complaints.

• Concentrate on member and provider appeals that pertain to medical necessity.

• Offer clinical expertise and consultation to the Medicaid grievance and appeals team.

• Lead or co-lead Medicaid appeals committee meetings.

• Primarily serve the Southeast Region, which includes Florida, Kentucky, Louisiana, and West Virginia.

⛳️ Requirements

• A minimum of five (5) years of experience in a healthcare delivery system, such as clinical practice or within the healthcare industry.

• Possession of an active state medical license with no encumbrances.

• Capability to secure licensure in Florida, Kentucky, Louisiana, and West Virginia.

• Board certification in a specialty recognized by the American Board of Medical Specialties (ABMS).

• M.D. or D.O. degree required.

• Board certification in a specialty recognized by either ABMS or the American Osteopathic Association (AOA).

• Experience providing direct patient care after completing postgraduate education.

• Preferred qualifications include specialties in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics.

• Preferred: Prior experience with Medicaid policy and Dynamo Appeals and Grievances (DAG).

• Preferred: Experience in managed care, particularly in utilization management.

• Preferred: Previous involvement in the appeals process.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Target award in the company’s equity award program.

• Comprehensive medical coverage.

• Dental coverage available.

• Vision coverage offered.

• Paid time off provided.

• Options for retirement savings.

• Wellness programs included.

• Additional resources available to support physical, emotional, and financial well-being.