Medical Director – Commercial Appeals
| Company | CVS Health |
|---|---|
| Location | Kansas, USA, Pennsylvania, USA, Oregon, USA, Iowa, USA, California, USA, Texas, USA, Jackson Township, NJ, USA, Florida, USA, Nevada, USA, South Carolina, USA, Georgia, USA, Arizona, USA, Minnesota, USA, Colorado, USA, Utah, USA, Kentucky, USA, West Virginia, USA, New York, NY, USA, Wisconsin, USA, North Carolina, USA, Oklahoma, USA, Missouri, USA, Louisiana, USA, Michigan, USA, Illinois, USA, Idaho, USA |
| Salary | $174070 – $374920 |
| Type | Full-Time |
| Degrees | MD |
| Experience Level | Senior, Expert or higher |
Requirements
- Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Prior UM (Utilization Management) experience
- Active and current state medical license without encumbrances
- M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.
Responsibilities
- Provide oversight for medical policy implementation.
- Support the Medical Management staff ensuring timely and consistent responses to members and providers.
- Focus primarily on review appeal cases for denied medical services.
- Provide clinical, coding, and reimbursement expertise as well as directing case management when necessary.
- Act as a business and clinical liaison to network providers and facilities if needed, to support the effective execution of medical services programs by the clinical teams.
Preferred Qualifications
- Active and current state medical license in CA without encumbrances and willing to obtain an AZ medical license “if needed”.
- Internal Medicine background