Lead Senior Medical Director

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 devel