Medical Director - Medicaid Appeals

Aetna, a CVS Health Company, is seeking a Medical Director to support the Southeast Region (Florida, Kentucky, Louisiana & West Virginia) with a focus on Medicaid Appeals. This remote role involves ensuring timely responses to member and provider appeals, state fair hearings, and escalated complaints. The Medical Director will provide clinical expertise to the Medicaid grievance and appeals team and chair/co-chair Medicaid appeals committee meetings. Practice Info This is a remote based (work at home) position based anywhere in the US. This role primarily supports the Southeast Region (Florida, Kentucky, Louisiana & West Virginia). Responsibilities Support the Medical Management staff ensuring timely and consistent responses to member and provider appeals, state fair hearings, and escalated complaints. Focus primarily on member and provider appeals related to medical necessity. Provide clinical expertise and consultation to the Medicaid grievance and appeals team. Chair/co-chair Medicaid appeals committee meetings. Compensation The typical pay range for this role is: $174,070 - $374,920. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Requirements Five (5) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry. An Active state medical license without encumbrances as well as the ability to obtain FL, KY, LA & WV licensure. Board Certified in ABMS Recognized Specialty. M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience. Preferred: Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics specialty. Preferred: Previous experience in Medicaid Policy and the use of Dynamo Appeals and Grievances (DAG). Preferred: Prior managed care experience in utilization management. Preferred: Prior experience in appeals.