Senior Network Medical Director, Northeast Region

CVS Health • Work At Home-Connecticut, CT

1d • $184,112 - $396,550

About The Position

Aetna, a CVS Health company, is seeking an enterprise clinical leader to shape and execute its approach to provider-network performance in the Northeast Region. The role adapts corporate network strategy to regional needs and capabilities and is accountable for provider-group outcomes in cost of care, quality, and member experience, working closely with the regional Network team.

The Senior Network Medical Director leads clinical relationships with healthcare providers and helps determine which partnerships to start, continue, or stop. The role evaluates provider performance and works with providers from a clinical perspective to support success on behalf of members. It also collaborates with Network, analytics, and actuarial teams and participates in the leadership of the Medical Affairs network team across all lines of business.

Requirements

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).
• Active and current MD or DO medical license without encumbrances.
• Board certification, including Maintenance of Certification, in a specialty of the American Board of Medical Specialties.
• Five years of work experience in managed care, value-based care, and quality.
• Three years of work experience in value-based care and quality.
• Ability to work effectively in a highly matrixed organization or environment.
• Ability to engage with physicians, vendors, community partners, administrative leaders, clinical leaders, and staff at all levels.
• Ability to manage multiple priorities, adapt to change, and work with agility.
• Ability to work virtually with occasional travel for in-person meetings.

Nice To Haves

• MBA or MPH.
• Medical informatics and/or data science experience.
• Location in the Northeastern United States.

Responsibilities

• Serve as the primary clinical leader for relationships with healthcare providers in the Northeast Region, working closely with and guiding senior clinical specialists.
• Fill in for other regions as needed while the team is growing.
• Partner with Network, analytics, and actuarial teams to evaluate provider performance on total cost of care, quality, and experience.
• Shape provider-engagement strategy, including decisions about where to expand or contract relationships.
• Take accountability for provider-group performance on cost, quality, and experience, including line-of-business measures such as MA Stars.
• Participate in the Medical Affairs network team leadership, working collaboratively to improve provider performance across all lines of business.
• Ensure timely execution of deliverables in accordance with due dates and federal and state regulatory requirements.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.
• An award target in the company's equity award program.

What This Job Offers

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