Medical Director - Sr Clinical Solution - Population Health (Medicare)

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. Job Purpose and Summary: The Sr. Clinical Solutions Medical Director, Population Health, Medicare position will serve as the liaison between data analytics/reporting teams and the clinical leadership team to identify trends in population health while providing a clinical perspective to effectively communicate and support clinical solutions aimed at improving patient care, safety and health outcomes of the Medicare membership. The role will leverage existing data and reporting sources as well as develop new analytics to support health plan senior leadership to identify, develop, implement, and evaluate the effectiveness of strategic initiatives including trends, policies and programs, designed to drive the delivery of high value healthcare supporting a sustainable competitive business advantage for members. Report directly to the VP/CMO Medicare and take direct assignment of significant projects which are foundational to the Medicare Medical Affairs agenda. Primary Job Duties & Responsibilities: The Sr. Clinical Solutions Medical Director, Population Health, Medicare provides: Responsibilities Analyze policy/procedure/workflows on case management and utilization management for care redesign Analyze Total Cost of Care, Stars, Risk Adjustment, etc. data for opportunities and propose Strategic Action Items and other initiatives to improve outcomes Work collaboratively with Medical Economics Unit, Analytics and Behavioral Change, Aetna Clinical Services and Medical Affairs' other departments to improve Medicare business operations and clinical program execution Develop and improve Medicare reporting, such as, in Tableau Lead and implement informatics communication efforts Strong collaborative relationship with care management teams Active participation in meetings and communications, including team meetings, leadership meetings, at the health plan local, state, regional or national levels Other duties as assigned Qualifications Board certification in Medical Informatics preferred Masters in related field preferred 5 years work experience in managed care required (preferably in Medicare) Experience in care model design and implementation, population health program development and/or clinical product development preferred Medical informatics and/or data science experience preferred Care Redesign experience required Must meet COVID-19 requirements This is a remote/work from home position within the United States Education Active and current state medical license without encumbrances M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience Pay Range 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. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of 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. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 05/26/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr