Lead Senior Medical Director DSNP

CVS Health•Island, KY

4d•$184,112 - $396,550•Remote

About The Position

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 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.

Requirements

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%

Nice To Haves

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.

Responsibilities

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
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.
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