Case Management Medical Director

• Provides clinical oversight of the case management teams and the Interdisciplinary Care Team (ICT) processes
• Participate in the development of members' Individual Care Plans (ICP)
• Provide clinical guidance for Long Stay, Palliative Care, Transition of Care and/or other CM clinical initiatives/rounds
• Contribute to strategies, tactics and programs for case management and community engagement
• Leverage available clinical platforms for case review
• Provide clinical guidance and leadership to CM & clinical team colleagues
• Collaborates with the Learning and Performance Team to develop clinical training
• Provider outreach to collaborate & solution around member needs
• Provide CM NP with guidance and oversight on Clinical rounds
• Provides clinical review and adjudication of MCR Appeals case when needed
• Professional Development: oversee and manage 1 Regional CM initiative
• Ensures timely execution of all deliverables in accordance with due dates and Federal/state regulatory requirements
• Travel to Provider, Member Meetings as indicated

• Active and current medical license (MD or DO) without encumbrances
• Board Certification including Maintenance of Certification in Family Practice, Internal Medicine, or Geriatrics
• Post-graduate 5 years of direct patient care experience
• 3-5 years of Managed Care experience
• Medicare highly preferred
• 3-5 years of Case Management experience
• 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 Member and Provider Meetings (10%)
• Flexibility with work schedule to meet business needs

Medicare experience highly preferred

• Affordable medical plan options
• 401(k) plan with matching company contributions
• Employee stock purchase plan
• No-cost wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
• CVS Health bonus, commission or short-term incentive program
• Equity award program