Executive Medical Director, Value-Based Care

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.

Job Purpose & Summary

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. And we do it all with heart, each and every day.

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 driving 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.  They will adapt the med affairs network strategy to the needs and capabilities of this segment of providers, and be accountable for outcome performance in this segment in close collaboration with the Network value-based team. They will be a clinical leader in determining what partnerships to start, continue, or stop, in evaluating provider performance, and in partnering with those providers from a clinical perspective to support their success on behalf of our members.  As part of this work, they will lead a team of senior clinical specialists who will work closely with them to drive performance and partnerships with portions of their portfolio. 

We are seeking a bold, systems-level thinker and clinical leader with deep expertise in strategic planning, value-based care delivery operations, and/or top-tier management consulting or equivalent. Join us in this exciting opportunity as we seek to be the best health plan partner in the country for value-based healthcare providers.

Primary Job Duties & Responsibilities

• Serve as primary clinical leader for our 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, including 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.

Required Experience & Qualifications

• 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 Experience & Qualifications

• MBA or MPH

• Medical informatics and/or data science experience

Education

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.