Executive Medical Director, Value-Based Care

About the role

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues—caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate.

Aetna, a CVS Health company, is leading the industry in service of our members, providers, and plan sponsors across Medicare, Medicaid, and Commercial. Medical Affairs is a clinically focused center of excellence working in close collaboration with all Aetna business units and cross-enterprise partners, to ensure high value care and best-in-class operating and clinical models. We collaborate with members, providers, and community organizations in pursuit of quality solutions that address the full continuum of member health care and social determinant needs.

We are in search of an Executive Medical Director who will serve as an enterprise clinical leader in shaping and executing our strategy to drive performance on cost of care, quality, and member experience with our network of value-based providers including advanced primary care clinics, complex care providers, and specialty value-based providers. This role will adapt the medical affairs network strategy to the needs and capabilities of this segment of providers and be accountable for outcome performance in close collaboration with the Network value-based team. The Executive Medical Director will be a clinical leader in determining partnerships, evaluating provider performance, and partnering with providers from a clinical perspective to support their success on behalf of our members.

Responsibilities

• Serve as primary clinical leader for relationships with advanced primary care, value-based specialty care, and complex care providers, working closely with and leading assigned senior clinical specialists.
• Partner with Network value-based contracting team and analytics and actuarial teams to evaluate performance on total cost of care, quality, and experience for these providers.
• Be a proactive strategic leader in shaping our strategy for engagement with these types of providers, including where to expand or contract our relationships.
• Take accountability for performance of these groups on cost, quality, and experience, including measures of importance to lines of business, such as MA Stars.
• Be a part of the leadership team of the medical affairs network team, collaboratively working toward improving provider performance across all lines of business.
• Ensure timely execution of all deliverables in accordance with due dates and Federal/state regulatory requirements.

Requirements

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).
• Active and current medical license (MD or DO) without encumbrances.
• Board Certification including Maintenance of Certification in specialty of American Board of Medical Specialties.
• 5-10 years work experience in the areas of managed care, value-based care, and quality.
• 5 years work experience in value-based care delivery.
• Ability to work effectively in a highly matrixed organization/environment.
• Ability to engage at all levels, including physicians, vendors, community partners, administrative leaders, clinical leaders, and staff.
• Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm.
• Ability to work virtually with occasional travel for in-person meetings.

Preferred Qualifications

• MBA or MPH.
• Medical informatics and/or data science experience.

Pay

The typical pay range for this role is $227,630.00 - $490,280.00. This pay range represents the 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, as well as an award target in the company’s equity award program.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. Benefits include:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.