Sr Clinical Solution MD – Population Health (Medicare)

CVS Health • Prior Lake, MA

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. Position Summary The Sr. Clinical Solutions Medical Director, Population Health, Medicare position 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. Report directly to the VP/CMO Medicare and take direct assignment of significant projects which are foundational to the Medicare Medical Affairs agenda.

Requirements

• Board certification in Medical Informatics preferred
• Masters in related field preferred
• 5 years work experience in managed care required (preferably in Medicare)
• Experience in care model design and implementation, population health development and/or clinical product development preferred
• Medical informatics and/or data science experience preferred
• Care Redesign experience required
• Must meet COVID-19 requirements
• This is a remote/work from home position within the United States
• This role requires overnight travel up to 30% of the time
• 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

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' 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

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees