Lead Senior Medical Director

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 populations—primarily DSNP/FIDE—and 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. The position is fully remote, full‑time, Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. 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 Develop and implement the framework for problem solving (“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 Involve in strategy and goal setting, clinical leadership Clinical Oversight for DSNP/FIDE & Complex Populations Provide 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 and 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 Assist in developing, implementing, and interpreting 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) Spend 20% of time on cross‑functional projects and initiatives Hold functional P&L responsibility at the large account level for the markets involved Own 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 Pay Range The typical pay range for this role is: $184,112.00 - $396,550.00. 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. Benefits 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. Benefits include medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources, based on eligibility. Equal Opportunity Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement