Lead Senior Medical Director

Lead Senior Medical Director

We're building a world of health around every individual shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person, one family and one community at a time.

*** This is a fully remote, full-time position requiring availability Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. ***

Position Summary:

Under the leadership and direction of the Executive Medical Director for Duals, the Lead Senior Medical Director provides strategic leadership and clinical oversight for complex populationsprimarily DSNP/FIDEand is responsible for leading a team of Senior Medical Directors/Medical Directors within the Center of Excellence (COE) Duals. This role drives medical management programs and policies that improve quality, cost, and outcomes across the continuum of care; integrates medical, behavioral, and social drivers of health; serves as a clinical and business liaison to internal teams, network providers, and state agencies; and ensures compliance, operational excellence, and superior member experience.

Key Responsibilities:

Leadership & Team Management

• Lead, coach, and develop a team of Senior Medical Directors; foster collaboration among peers
• Manage coverage schedules, vacations, team assignments, and change management.
• Provide ongoing coaching and feedback to ensure peak performance; build a culture of continuous improvement and integrity
• Development of "How" to solve the problem
• Actively participate in scheduled team and leadership meetings at health plan, local, state, regional, and national levels supporting the EMD.
• Strategy involvement, supporting goal setting, clinical leadership

Clinical Oversight for DSNP/FIDE & Complex Populations

• Responsible for clinical oversight of DSNP/FIDE complex populations.
• Develop and lead clinical strategy and objectives for DSNP/FIDE, including clinical initiatives/programs to improve outcomes.
• Facilitate/Improve interdisciplinary care team rounds for DSNP/FIDE members
• Confer directly with CMOs/SMDs/MDs regarding care of patients with severe, complex, and/or treatment-resistant illnesses through peer review and educational interventions.

Medical Management, Quality & Programs

• Ensure compliance with clinical goals by monitoring care management performance; expand medical management programs to address member needs.
• Assists to develop, implement, and interpret medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments.
• Develop and guide implementation of programs ensuring providers deliver appropriate, high-quality, cost-effective health risk assessments (HRAs) and other evidence-based services.
• Support preparation for program audits and/or certification processes; actively participate in internal/external quality improvement activities.
• Help achieve or exceed HEDIS, Stars, and state performance targets; support Clinical Quality initiatives and peer review processes (Quality of Care and Quality of Service/grievance).
• 20% of time on Cross Functional projects and initiatives
• Functional P&L responsibility at the large account level for the markets involved
• Owns the performance of the whole business relationships

Performance Metrics & Success Measures

Clinical Outcomes (Quality): Preventive care & screening performance (HEDIS), chronic disease control (HbA1c, BP), transitions of care, hospital readmissions/PCR, medication adherence.

Utilization & Cost: Avoidable ED utilization, ambulatory-care sensitive admissions, total cost of care (PMPM), risk adjustment accuracy.

Member Experience & Equity: CAHPS scores, care coordination timeliness, health equity improvements.

Operational Performance: Program adoption/enrollment, provider engagement, compliance audit results, interdisciplinary rounds completion.

Subject matter expert on regions assigned / workstream

Regional responsibilities, assigned for assigned territory and oversight

Required Qualifications:

• MD or DO degree.
• Current, active, unencumbered, unrestricted physician licenses in any state
• Current and active Board Certification in an American Board of Medical Specialties discipline
• 5+ years post-residency clinical practice, including complex population experience (minimum three years of specialty training).
• 3+ years of managed care industry experience.
• Ability to travel 10%
• Proven ability to develop relationships with network/community physicians and providers.

Preferred Qualifications:

• Current, active, unencumbered, unrestricted physician licenses in IL, MI, NJ, and/or VA preferred
• 1+ years of management experience leading a team of doctors/nurses with direct reporting
• Strong proficiency with MedCompass
• Project management or active project participation experience.
• Substantial experience using electronic clinical systems.
• Solid data analysis and interpretation skills with focus on key metrics.
• Demonstrated team-player and team-building skills
• Proven strategic thinking with ability to communicate a vision and drive results.
• Solid negotiation and conflict management skills; creative problem-solving skills.

Education:

MD or DO, Board Certification as stated above

The typical pay range for this role is:

$184,112.00 - $396,550.00

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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. 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.

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 people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our 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.