Senior Medical Director - FIDE IL

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 full-time, remote role. The ideal candidate will live in the state of IL.

Primary Responsibilities

• Responsible for clinical oversight of DSNP/FIDE complex populations (Duals Special Needs)
• Develop and lead clinical strategy and objectives for the DSNP/FIDE populations, including the development and implementation of clinical initiatives and programs to address the needs of the populations managed to improve health outcomes.
• Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for DSNP/FIDE and other complex health populations to optimize risk adjustment, clinical quality, and care management.
• Actively participate in meetings and communication with the State Department of Medicaid in person as needed.
• Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community, state regulatory agencies and advocacy groups to advance clinical excellence and the delivery of cost-efficient care. Will also Interact with the members, health systems, nursing facilities, as well as home and community-based networks. Make face to face visits with medical / physical professional associates, the local provider community, state regulatory agencies and advocacy groups for discussions for trend discussions. Attend In person provider and Member meetings as needed.
• Develop and guide the implementation of medical management programs to ensure providers deliver appropriate, high-qu