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. **Position Summary** Aetna is an industry leader in serving eligible populations by utilizing best-in-class operating and clinical models in our programs. We collaborate with members, providers, and community organizations in pursuit of quality solutions that address the full continuum of our members’ health care and social determinant needs. The Case Management (CM) Medical Director will participate in executing and deploying our Models of Care across all assigned markets. This is a work from home position with 2 Regions located in Eastern Time Zone and 1 Region in Central Time Zone. The ability to work either of those Time Zones is Highly Preferred. They will facilitate active and impactful care coordination focused on care transition, communication between members, physicians and internal/external business partners to ensure program design effectiveness, member safety and quality of care delivery. Join us in this exciting opportunity as we grow and expand into new markets across the country. **Primary Duties and Responsibilities:** • Provides clinical oversight of the case management teams and the Interdisciplinary Care Team (ICT) processes by participating in the development of members’ Individual Care Plans (ICP) and assisting case management staff as they support of members’ physical, behavioral and socioeconomic needs. • 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 of members, community partners and providers to create unique local strategies as needed. • Leverage available clinical platforms for case review; i.e. EPIC Everywhere • Provide clinical guidance and leadership to CM & clinical team colleagues (SW & Pharmacy). • Collaborates with the Learning and Performance Team to develop clinical training for case management staff such as 5 "Clinical Pearls" ppt presentations yearly. • Provider outreach to collaborate & solution around member needs • Provide CM NP with guidance and oversight on Clinical rounds case prep, case selection, provider & member outreach when warranted. • Provides clinical review and adjudication of MCR Appeals case when needed • Professional Development: oversee and manage 1 Regional CM initiative in collaboration and guidance of CM SMD. • Ensures timely execution of all deliverables in accordance with due dates and Federal/state regulatory requirements. • Travel to Provider, Member Meetings as indicated **Required Qualifications** • 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 • Flexibility with work schedule to meet business needs • 3-5 years of Managed Care experience; Medicare highly preferred • 3-5 year 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%) **Education** MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) **Pay Range** The typical pay range for this role is: $174,070.00 - $374,920.00 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. 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 – 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 https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 08/29/2025 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.