Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary: * *Primary Responsibilities:* • Responsible for clinical oversight of DSNP/MMP complex populations (Duals Special Needs/MMP • 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/MMP and other complex health populations to optimize risk adjustment, clinical quality, and care management • Actively participate in meetings and communication with the state Departments 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. In person provider and Member meetings. • Develop and guide the implementation of medical management programs to ensure providers deliver appropriate, high-quality, cost-effective health risk assessments and other clinical services that are evidence-based • Work collaboratively with the Behavioral Health, Pharmacy, member outreach, Care Management, National Quality Management, Utilization Management, Compliance, and other departments to integrate social, behavioral, and physical health and improve clinical program execution. • In collaboration with health care analytics teams, develop analytical models, interpret results, and extract insights on the clinical drivers and trends and tracks data to improve the delivery of population health care to create value for members, providers, and the health plan. Understand trend and create solutions. Good with data interpretation. • Be able to effectively communicate these finding to Senior Management and staff at all levels. • Develop and deliver conference presentations or other presentations (written or oral) that support the health plan in a professional and effective manner. • Actively participate in State Fair Hearings as needed. Understand UM and participate in UM front line work and appeals as needed in OH and other markets as needed • Confer directly with providers regarding the care of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. • Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals clinical review. • Actively participate in scheduled team meetings and leadership meetings, at the health plan, local, state, regional, or national levels. • Facilitate interdisciplinary care team rounds for DSNP/MMP members. • Develop effective working relationships with internal clinical team, facilitate educational and coaching opportunities for the internal clinical team, as well as establish relationships and/or consult with external agencies in pursuit of the IHI Triple Aim. Must be willing to cross cover for other colleagues and become mentor for other MDs as needed. • Partner with appropriate entities in the investigation of potential quality of care concerns and/or grievances • Actively support compliance functions to maintain standardized systems, policies, programs, procedures, and workflows that ensure the health plan exceeds care management, regulatory, and quality standards • Support the activities of the Chief Medical Officer and other plan leadership as required or assigned. • Be an active voice and participate in all internal and external committee meetings • Actively participate in quality improvement activities internal and external to the organization with multiple stakeholders • Help achieve or exceed all applicable HEDIS, Stars and local state performance targets and goals otherwise specified for the plan Be present for regulatory audits in person • Support all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service (grievance) issues • Actively participate in or lead quality and/or member/provider service-focused committees • Provide clinical leadership in preparation for program audits and/or certification processes *Required Qualifications * • MD or DO degree Board Certified in Internal Medicine, Family Medicine, or Geriatric Medicine. Licensed in OH at a minimum, ability to get licensure in NY, NJ, VA, OH , MI as needed. • Active Unrestricted Board Certification in ABMS or AOA specialty • 5+ years of clinical practice experience post residency, including experience with complex health populations and services (must have at least three years of training in a medical specialty). • 3+ years of experience in the managed care industry. • 1 year LTSS/MLTSS experience. • Experience in leading inter-disciplinary teams. • Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles. • Domiciled in the State of Ohio / Residency is Required. • Ability to travel on as needed basis. • Proven ability to develop relationships with network and community physicians and other providers. Education: MD or DO Boarded in a primary care specialty (Internal Medicine, Family Medicine, Geriatrics) *Pay Range* The typical pay range for this role is: $184,112.50 - $396,600.00 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 06/17/2024
Apply on company website
Find Connections via Linkedin
