Medical Director- Population Health, IL

R0809581 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. • The Medical Director of Transitional Care leads the Illinois Transitional Nursing team and supports national initiatives to improve care coordination across multidisciplinary teams. This role ensures high-quality, patient-centered transitions from inpatient to outpatient settings, aiming to reduce readmissions and enhance satisfaction. Responsibilities include team oversight, program development, compliance monitoring, and data-driven decision-making. The ideal candidate is a licensed RN with strong leadership, clinical, and communication skills, and experience in transitional nursing, discharge planning, or home health. • Job Description Role Description: The Medical Director, Transitional Care, APP is responsible for leading the IL Transitional Nursing team as well as providing programmatic support to national leadership and transitional staff. The Transitions of Care program focuses on providing a multi-disciplinary connection between Care Navigation, Utilization Management, facility, local care teams and patient/family. The Manager role provides leadership in executing the Transitions of Care program goals which include ensuring high-quality, patient-centered care; preventing avoidable readmissions; and managing efficient resource utilization and improving patient and provider satisfaction. Responsibilities: Serving as the Subject Matter Expert on Transitions of Care Leading the IL market Transitional Care team including the oversight of daily operations, maintaining regional/facility assignment, balancing of staff caseloads, monitoring team/individual performance and coaching staff when appropriate, providing coverage and support as needed. Providing direct or supporting efforts in the hiring and training of Transitional Care staff in new and existing markets Assisting the department of Medical Management in the development, execution and improvement of the Transitions of Care program Helping all markets resolve specific needs as related to Transitional Care navigation Executing effective collaboration between multi-disciplinary teams including but not limited to: Care Navigation, Utilization Management, facilities, local care teams and patient/family Having firm knowledge and executing CMS, state-specific and NCQA compliance criteria as related to Transitions of Care Monitoring data related to patient cost, admissions, post-discharge appointment completion and health outcomes to help guide and direct Transitions of Care program initiatives and goals Participates in daily inpatient and post-acute rounding calls with Care Navigation and UM teams to help determine patient status and appropriate discharge plan What we are looking for: Education: Bachelor degree in Nursing required, Master’s degree preferred Experience: >7 years or relevant experience with a minimum 2 years of direct supervisory experience and 2+ years of experience in transitional nursing, discharge planning or home health Registered Nurse (RN) license in good standing with no restrictions required. Nurse Case Management Credentialing (RN-BC) or Certified Case Manager (CCM) preferred Experience in utilization management Knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria Strong clinical and assessment skills Outstanding verbal and written communication skills Ability to work independently and maintain flexibility in a fast-paced, start-up environment Ability to analyze data and use it to improve care delivery Self-starter with a high level of accountability and responsibility for the outcome of care Highly organized and able to manage multiple priorities appropriately Independent problem-solving skills Able to work collaboratively and build enduring relationships with providers, patients and the multidisciplinary team. A flexible, positive attitude Valid driver's license and ability to travel daily Working knowledge of Microsoft Office Product Suite Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $121,514.00 - $261,723.00 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. 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: 05/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job