Appeals Medical Director – Medicare

Skip to main contentWe care about your privacyBy clicking "Accept All", you agree to the storing of cookies on your device to give you the most optimal experience using our website. We may also use cookies to enhance performance, analyze site usage and to personalize your experience.Read Full Privacy MessageDeclineAccept CookiesCareers at Elevance HealthEnglishSign InAppeals Medical Director – Medicare page is loadedAppeals Medical Director – MedicareApplylocationsIN-INDIANAPOLIS, 220 VIRGINIA AVENJ-ISELIN, 111 S WOOD AVE, STE 220OH-COLUMBUS, 8940 LYRA DR, STE 300MD-HANOVER, 7550 TEAGUE RD, STE 500FL-MIAMI, 11430 NW 20TH ST, STE 200 & 300View All 12 Locationstime typeFull timeposted onPosted 7 Days Agotime left to applyEnd Date: August 14, 2026 (23 days left to apply)job requisition idJR199403Anticipated End Date:2026-08-14Position Title:Appeals Medical Director – MedicareJob Description:Appeals Medical Director – Medicare   Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered.  The Appeals Medical Director is responsible for the appeal reviews for physical health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities.How you make an impact:Appeal Reviews.Supports clinicians to ensure timely and consistent responses to members and providers.Provides guidance for clinical operational aspects of a program.May conduct peer-to-peer clinical case reviews with attending physicians or other ordering providers to discuss review determinations.Serves as a resource and consultant to other areas of the company.May be required to represent the company to external entities and/or serve on internal and/or external committees.May chair company committees.Interprets medical policies and clinical guidelines.May develop and propose new medical policies based on changes in healthcare.Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.Identifies and develops opportunities for innovation to increase effectiveness and quality.Minimum Requirements:Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).Must possess an active unrestricted medical license to practice medicine or a health profession.Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.Preferred Qualifications:Primary Care specialties preferred.Utilization Management or Appeals...