Lead Senior Medical Director

CVS Health • Island, KY

1d • 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%
• Proven ability to develop relationships with network/community physicians and providers.

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

• 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

Benefits

• 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.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree