Sr Clinical Solution MD - Population Health (Medicare)
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.
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
Required Qualifications
- 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
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: $184,112.00 - $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. 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 Apply tot his job Apply To this Job