Senior Network Medical Director, West Region

CVS Health•Work At Home-California, CA

2d•$184,112 - $396,550

About The Position

CVS Health is seeking a Senior Network Medical Director to serve as an enterprise clinical leader for provider relationships in the West Region. The role shapes and executes the regional approach to improving cost of care, quality, and member experience, adapting corporate network strategy to regional needs and capabilities. The director is accountable for regional provider outcomes in close collaboration with the Network regional team and helps determine which provider partnerships to start, continue, or end. The position also partners clinically with providers to support their success on behalf of members. The director works across Aetna business units and enterprise partners as part of Medical Affairs, a clinically focused center of excellence. The role contributes to improving provider performance across lines of business and ensures deliverables are completed on time and in accordance with federal and state regulatory requirements. The position involves virtual work with occasional travel for in-person meetings.

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 West United States.

Responsibilities

Serve as the primary clinical leader for relationships with healthcare providers in the West Region, working with and guiding senior clinical specialists; provide coverage for other regions as needed while the team grows.
Partner with Network, analytics, and actuarial teams to evaluate provider performance on total cost of care, quality, and experience.
Shape engagement strategy for value-based healthcare providers, including deciding where to expand or contract relationships.
Take accountability for provider-group performance on cost, quality, and experience, including measures important to lines of business such as Medicare Advantage Stars.
Participate in the Medical Affairs network team leadership group and collaborate to improve provider performance across all lines of business.
Ensure timely completion of deliverables in accordance with due dates and federal and state regulatory requirements.
Partner with providers from a clinical perspective to support their success on behalf of members.