Chief Medical Officer Managed Long-Term Care (MLTC)

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:

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.