Senior Medical Director

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $184.1k - $396.6k / year

⏰ Full Time

🟠 Senior

👨‍⚕️ Medical Director

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Provide clinical oversight of DSNP/FIDE complex populations • Develop and lead clinical strategy, objectives, initiatives, and programs for DSNP/FIDE populations • Optimize risk adjustment, clinical quality, and care management using knowledge of healthcare delivery, utilization management, reimbursement, and treatment protocols • Participate in meetings and communications with the State Department of Medicaid, including in-person participation as needed • Collaborate with medical professionals, providers, regulatory agencies, advocacy groups, members, health systems, nursing facilities, and home- and community-based networks • Develop and guide medical management programs supporting evidence-based, high-quality, cost-effective clinical services • Collaborate with Behavioral Health, Pharmacy, member outreach, Care Management, Quality Management, Utilization Management, Compliance, and other departments • Develop analytical models, interpret results, track trends, and create population health solutions with healthcare analytics teams • Communicate findings to senior management and staff • Develop and deliver professional conference and other presentations • Participate in State Fair Hearings, State calls, utilization management, appeals, and front-line UM work as needed • Confer with providers regarding severe, complex, or treatment-resistant illnesses through peer review and education • Support inpatient care management, clinical coverage review, member appeals, medical claims review, and provider appeals review • Participate in team and leadership meetings at health plan, local, state, regional, and national levels • Facilitate interdisciplinary care team rounds for DSNP/FIDE members • Mentor and coach internal clinical teams, cross-cover colleagues, consult with external agencies, and be on call as needed • Investigate potential quality-of-care concerns and grievances • Support compliance functions and standardized systems, policies, programs, procedures, and workflows • Participate in internal and external committees and quality improvement activities • Help achieve HEDIS, Stars, and local state performance targets • Participate in regulatory audits and support clinical quality, peer review, grievance, service, and certification activities

🎯 Requirements

• MD or DO Degree • Currently Board Certified in Internal Medicine, Family Medicine, or Geriatric Medicine; Board Eligible does not meet requirements • Active unrestricted board certification in an ABMS or AOA specialty • Licensed in IL • Ability to get licensure in New York, New Jersey, Virginia, and Michigan as needed • 5+ years of clinical practice experience post residency • At least three years of training in a medical specialty • Experience with complex health populations and services • Overnight travel required based on business needs • Preferred: 3+ years of experience in the managed care industry • Preferred: Experience leading inter-disciplinary teams • Preferred: Understanding of evidence-based medicine and managed care principles • Preferred: Ability to develop relationships with network and community physicians and other providers • Preferred: Residency in IL or ability to travel to IL within 24 hours

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being