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Bringing our heart to every moment of your health.
Lead Senior Medical Director
Location
United States
Posted
86 days ago
Salary
$184K - $396K / year
Seniority
Lead
No structured requirement data.
Job Description
Lead Senior Medical Director
CVS Health
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. Key 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 Required Qualifications: • 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. Preferred Qualifications: • 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. Education: MD or DO, Board Certification as stated above Pay Range The typical pay range for this role is: $184,112.00 - $396,550.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Anticipated End Date: 2026-03-26 Position Title: Nurse Case Manager I Job Description: Nurse Case Manager I Hours: 9am-530pm with 2-3 late evenings a month 1130am-8pm Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Nurse Case Manager I is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning How you will make an impact: - Ensures member access to services appropriate to their health needs. - Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. - Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. - Coordinates internal and external resources to meet identified needs. - Monitors and evaluates effectiveness of the care management plan and modifies as necessary. - Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. - Negotiates rates of reimbursement, as applicable. - Assists in problem solving with providers, claims or service issues. - Assists with development of utilization/care management policies and procedures Minimum Requirements: - Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. - Current, unrestricted RN license in applicable state(s) required. - Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: - Certification as a Case Manager is preferred. - BS in a health or human services related field preferred For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $70,560- $105,840 Locations: New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

