Appeals Medical Director – Cardiology

Elevance Health

Appeals Medical Director responsible for overseeing Cardiology appeal reviews and improving healthcare quality. Requires extensive clinical experience and valid medical license.

Posted 5/27/2026full-timeIndianapolis • California, Maryland, Massachusetts, New Jersey, New York, Ohio, Virginia • 🇺🇸 United StatesLead💰 $247,840 - $446,112 per yearWebsite

About the role

Key responsibilities & impact

Responsible for the appeal reviews for physical health medical services
Supports clinicians to ensure timely and consistent responses to members and providers
Provides guidance for clinical operational aspects of a program
Conducts peer-to-peer clinical case reviews with attending physicians
Serves as a resource and consultant for other areas of the company
May chair company committees
Interprets medical policies and clinical guidelines
Identifies and develops opportunities for innovation to increase effectiveness and quality

Requirements

What you’ll need

Requires MD or DO, Board certification by ABMS or AOA is required
Must possess an active unrestricted medical license to practice medicine
Minimum of 10 years of clinical experience; or any combination of education and experience that provides equivalent background
For Health Solutions and Carelon organizations, 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

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Paid Time Off
Medical, dental, vision insurance
Short and long-term disability benefits
Wellness programs
Financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical case reviewsmedical policy interpretationclinical guidelines applicationprogram operational guidancepeer-to-peer consultations

Soft Skills

leadershipconsultationcommunicationinnovation developmentresource management

Certifications

MDDOBoard certification by ABMSBoard certification by AOAactive unrestricted medical license