Chief Medical Officer u2013 Managed Long-Term Care (...

At CVS Health, weu2019re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nationu2019s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues u2013 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. Position Summary: The Chief Medical Officer (CMO) serves as the senior clinical executive for the MLTC plan, responsible for overseeing all medical management functions, ensuring regulatory compliance, and driving quality improvement initiatives. The CMO provides strategic leadership to ensure that long-term care services are delivered in a person-centered, cost-effective, and clinically sound manner, in alignment with New York State Department of Health (NYSDOH) regulations. Key Responsibilities: Clinical Oversight + Lead development and implementation of clinical protocols and care standards for long-term services and supports. + Supervise medical directors, nurse practitioners, and care management teams. + Review and approve care plans for high-risk and complex members. Quality & Compliance + Ensure compliance with NYSDOH MLTC regulations, including UAS-NY assessments, service authorizations, and CDPAP oversight. + Monitor HEDIS and other quality metrics; lead performance improvement initiatives. + Prepare for and participate in regulatory audits and corrective action planning. Member Advocacy & Care Coordination + Promote culturally competent, person-centered care that reflects member preferences and social determinants of health. + Address clinical grievances and appeals; ensure timely resolution and documentation. + Support transitions of care and reduce avoidable hospitalizations. Provider Network Engagement + Oversee credentialing and performance evaluation of contracted providers. + Facilitate clinical education and dissemination of best practices across the network. + Resolve provider-related clinical issues and foster collaborative relationships. Strategic Leadership + Contribute to organizational strategy, especially around integrated care models (e.g., FIDE, MAP, PACE). + Lead innovation initiatives such as dementia care, telehealth, behavioral health integration, and home-based care. + Represent the MLTC plan in clinical discussions with state agencies, community partners, and stakeholders. Required Qualifications u2022 MD or DO degree with active New York State medical license. u2022 Board certification in Internal Medicine, Geriatrics, or related specialty preferred. u2022 Minimum 7u201310 years of clinical experience, with at least 5 years in managed care or health plan leadership. u2022 Deep understanding of MLTC, Medicaid, and long-term care policy in New York. u2022 Strong leadership, communication, and stakeholder engagement skills. Preferred Qualifications u2022 Experience with value-based care and population health analytics. u2022 Familiarity with UAS-NY, HEDIS, and NCQA accreditation standards. u2022 Passion for improving care for aging and disabled populations. Education MD or DO Pay Range The typical pay range for this role is: $184,112.00 - $396,550.00 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 companyu2019s 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 our comprehensive and competitive mix of pay and benefits u2013 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 all 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 access and many other benefits depending on eligibility. For more information, visit We anticipate the application window for this opening will close on: 11/28/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-01