Position SummaryThe Senior Medical Director, Clinical Solutions serves as the senior clinical leader supporting Medicare Advantage Group Plan Sponsors. This highly visible, external-facing role partners directly with employer groups, labor organizations, public sector clients, and other plan sponsors to drive clinical strategy, improve healthcare outcomes, optimize medical cost trends, and strengthen client satisfaction and retention.
The Senior Medical Director acts as a trusted clinical consultant and executive advisor, translating complex healthcare data into actionable strategies that support plan sponsors' goals. Working collaboratively with sales, account management, underwriting, actuarial, medical economics, population health, network management, utilization management, product, and care management teams, this leader develops and executes innovative solutions that improve member health outcomes while enhancing the value of Medicare Advantage offerings.
This role plays a critical part in both client growth and retention activities by participating in sales presentations, finalist meetings, and strategic customer engagements, serving as the clinical voice of the organization.
Travel: Approximately 25%
Key ResponsibilitiesClient and Plan Sponsor Engagement- Serve as the primary clinical advisor and relationship leader for assigned Medicare Advantage Group Plan Sponsors.
- Build and maintain executive-level relationships with key client stakeholders, including benefit leaders, medical advisors, union representatives, and purchasing decision-makers.
- Lead regular strategic reviews with plan sponsors to discuss:
- Medical and pharmacy utilization trends
- Population health opportunities
- Clinical program performance
- Cost drivers and risk factors
- Quality and STARS performance
- Emerging healthcare trends and innovations
- Present complex clinical, financial, and utilization data in a clear, meaningful, and actionable manner.
- Address and resolve escalated clinical inquiries while providing consultative recommendations aligned with client objectives.
Sales and Business Development Support- Partner with Medicare Advantage sales and account teams to support growth, retention, and client expansion opportunities.
- Participate in prospective client meetings, finalist presentations, renewals, and Request for Proposal (RFP) activities.
- Serve as the executive clinical spokesperson during sales engagements, articulating organizational clinical capabilities, outcomes, quality programs, and value propositions.
- Collaborate with market leadership to develop innovative clinical solutions that differentiate offerings in a competitive marketplace.
Clinical Strategy and Population Health Leadership- Analyze utilization, financial, claims, and population health data to identify opportunities for improving outcomes and reducing avoidable healthcare costs.
- Design and recommend clinical interventions, benefit strategies, and population health initiatives tailored to sponsor populations.
- Provide clinical leadership for programs focused on:
- Chronic disease management
- Preventive care
- Complex care management
- Behavioral health integration
- Health equity initiatives
- Care transitions and post-acute care optimization
- Partner with internal stakeholders to ensure clinical programs align with organizational and client objectives.
Clinical Leadership and Thought Partnership- Act as a senior physician leader and subject matter expert on Medicare Advantage clinical programs and CMS regulatory requirements.
- Stay current on healthcare policy, Medicare Advantage trends, clinical best practices, and population health innovations.
- Mentor and provide clinical guidance to internal teams, including Clinical Program Consultants and other business partners.
Support executive leadership with strategic initiatives, customer presentations, and complex client situations.
Required Qualifications- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited institution.
- Board Certification in an ABMS-recognized specialty.
- Active, unrestricted medical license.
- Minimum of 5 years of post-residency clinical practice experience.
- Minimum of 2 years of managed care, health plan, utilization management, population health, or payer experience.
- Experience analyzing healthcare utilization, quality, and financial performance data.
- Demonstrated success presenting to executive-level stakeholders and customers.
Preferred Qualifications- Experience supporting Medicare Advantage or Medicare Group products.
- Sales or consulting experience.
Education- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited institution.
- Board Certification in an ABMS-recognized specialty.
- Active, unrestricted medical license.
Pay RangeThe 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 company's equity award program.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 10/03/2026
