Medical Director - Medicare Appeals
: Job Details :

Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a remote based (work from home) role. Preferred candidates will have Internal Medicine or Internal Medicine / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight for medical policy implementation. You will support the Medical Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited Appeals / Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinica...Medical Director, Director, Appeals, Medical, Internal, Patient Care, Retail, Healthcare