• Job Description

  Req#: R0326246

  Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
  
  Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

  Position Summary

  Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
  
  **This is a remote based (work from home) role.**

  The Senior Medical Director – Population Health (Medicare) , is a key leadership role on the Medicare Chief Medical Officer’s team. In this role you will be responsible for setting strategic direction and implementation for Aetna’s Medicare Care Model care programs. You will work with key members of the Medical Affairs, clinical services and provider network teams; as well as across the enterprise on the ongoing development and implementation of operational processes, policies and procedures used in the delivery of integrated care models with an emphasis on population health. Additionally, you will serve as the liaison between data analytics/reporting teams and the clinical leadership team to identify trends in population health while providing a clinical perspective to effectively communicate and support clinical solutions aimed at improving patient care, safety and health outcomes of the Medicare membership. The role will leverage existing data and reporting sources, as well as develop new analytics to support health plan senior leadership to identify, develop, implement, and evaluate the effectiveness of strategic initiatives including trends, policies and programs, designed to drive the delivery of high value healthcare supporting a sustainable competitive business advantage for members.

  You'll report directly to the VP/CMO Medicare and take direct assignment of significant projects which are foundational to the Medicare Medical Affairs agenda.

  Responsibilities

  • Analyze policy/procedure/workflows on case management and utilization management for care redesign
  • Analyze Total Cost of Care, Stars, Risk Adjustment, etc. data for opportunities and propose Strategic Action Items and other initiatives to improve outcomes
  • Work collaboratively with Medical Economics Unit, Analytics and Behavioral Change, Aetna Clinical Services and Medical Affairs’s other departments to improve Medicare business operations and clinical program execution
  • Develop and improve Medicare reporting, such as, in Tableau
  • Lead and implement informatics communication efforts
  • Strong collaborative relationship with care management teams
  • Active participation in meetings and communications, including team meetings, leadership meetings, at the health plan local, state, regional or national levels
  • Other duties as assigned

  Required Qualifications

  • Active and current state medical license without encumbrances
  • M.D. or D.O., with ABMS Board Certification in a recognized specialty, including post graduate direct patient care experience.
  • 2+ years work experience in managed care (preferably for Medicare and/or dual-eligible beneficiaries)
  • 2+ years experience in care model design and implementation, population health program development and/or clinical product development.
  • Travel up to 20%.

  Preferred Qualifications

  • Board certification in Medical Informatics preferred
  • Masters in related field preferred
  • Medical informatics and/or data science experience.

  
  Education

  • Active and current state medical license without encumbrances
  • M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience

  Pay Range

  The typical pay range for this role is:

  $184,112.50 - $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.
  
  In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
  
  For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

  We anticipate the application window for this opening will close on: 09/27/2024

  Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• About the company

  At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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