Description

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:

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
• MD or DO degree with active New York State medical license.
• Board certification in Internal Medicine, Geriatrics, or related specialty preferred.
• Minimum 7-10 years of clinical experience, with at least 5 years in managed care or health plan leadership.
• Deep understanding of MLTC, Medicaid, and long-term care policy in New York.
• Strong leadership, communication, and stakeholder engagement skills.

Preferred Qualifications

• Experience with value-based care and population health analytics.

• Familiarity with UAS-NY, HEDIS, and NCQA accreditation standards.

• 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 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: 11/28/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.