Medical Director - Medicare Appeals

Job title: Medical Director - Medicare Appeals in Connecticut at reputed company Company: reputed company Job description: At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day.Position Summaryreputed company, a reputed company Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We reputed company that a reputed company 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 at home) based reputed company in the US.Responsibilities of this Medical Director role are reputed company to Part C Medicare Appeals. This position is primary on the non-regulated appeals team, however the expectation is to cross train for regulated appeals.

• Provide support to Medicare appeal nurses

• Provide after hours and weekend coverage on a rotational basis to support 72 hour turn around time

• Collaborative work with Medicare Quality and Compliance on an ongoing basis

• Provide ongoing education/ subject matter expertise regarding Medicare policy and appeals to the territory Utilization Management staff

• Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency

Required Qualifications

• Two (2) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry

• Medical License (MD) or (DO)

• An Active state medical license without encumbrances

• Board Certified in ABMS Recognized Specialty

Preferred Qualifications

• Medical Management - Medicare Complaints, Grievance & Appeals experience.

• Health Plan Experience Highly Preferred

Education

• Medical License (MD) or (DO)

Pay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. This position also includes an award reputed company in the company’s equity award program.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visitWe anticipate the application window for this opening will reputed company on: 06/27/2025reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Expected salary: Location: Connecticut Apply for the job now! Apply for this job