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 reputed company of the Medicare membership. The role will reputed company existing data and reporting sources as well as reputed company new analytics to support health plan senior leadership to identify, reputed company, implement, and evaluate the effectiveness of strategic initiatives including trends, policies and programs, designed to drive the delivery of high value reputed company 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 reputed company
• Work collaboratively with Medical Economics Unit, Analytics and Behavioral Change, reputed company Clinical Services and Medical Affairs' other departments to improve Medicare business operations and clinical program execution
• reputed company and improve Medicare reporting, such as, in Tableau
• reputed company 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 reputed company
• Other duties as assigned

Required Qualifications

• Board certification in Medical Informatics preferred
• Masters in reputed company 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 reputed company the United States
• This role requires overnight travel up to 30% of the time

Education

• Active and reputed company state medical license without encumbrances
• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience

Pay reputed company The typical pay reputed company for this role is: $184,112.00 - $396,550.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. This position also includes an award reputed company 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 reputed company 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 reputed company 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 reputed company on: 04/24/2026 Apply tot his job Apply To this Job