Medical Director- Population Health

Medical Director of Transitional Care, APP

At CVS Health, we’re building a world of health around every consumer. 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.

The Medical Director of Transitional Care leads the Illinois Transitional Nursing team and supports national initiatives to improve care coordination across multidisciplinary teams, ensuring high‑quality, patient‑centered transitions from inpatient to outpatient settings. This role reduces readmissions and enhances satisfaction through team oversight, program development, compliance monitoring and data‑driven decision‑making.

• Serve as the Subject Matter Expert on Transitions of Care.
• Lead the IL market Transitional Care team, overseeing daily operations, assigning staff to facilities, balancing caseloads, monitoring performance, coaching staff and providing coverage as needed.
• Hired and trained Transitional Care staff in new and existing markets.
• Assist the Department of Medical Management in developing, executing and improving the Transitions of Care program.
• Help all markets resolve specific needs related to Transitional Care navigation.
• Execute effective collaboration between multidisciplinary teams, including Care Navigation, Utilization Management, facilities and local care teams.
• Apply CMS, state‑specific and NCQA compliance criteria related to Transitions of Care.
• Monitor data on patient cost, admissions, post‑discharge appointments and outcomes to guide program initiatives.
• Participate in daily inpatient and post‑acute rounding calls to determine patient status and discharge plans.

• Education:
  
  Bachelor of Nursing required;
  Master’s preferred.
• Experience:
  
  7+ years in transitional nursing, discharge planning or home health, with at least 2 years of supervisory experience.
• Registered Nurse (RN) license in good standing with no restrictions.
• RN‑BC or Certified Case Manager (CCM) credential 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 for care outcomes.
• Highly organized and able to manage multiple priorities.
• Independent problem‑solving skills.
• Collaborative mindset and ability to build enduring relationships with providers, patients and multidisciplinary teams.
• Flexible, positive attitude.
• Valid driver’s license and daily travel capability.
• Working knowledge of Microsoft Office Suite.

40

Full time

$ - $

• Affordable medical plan options.
• 401(k) plan with company matching.
• Employee stock purchase plan.
• No‑cost wellness programs, including screenings, tobacco cessation, weight management, counseling and financial coaching.
• Benefit solutions for paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance, tuition assistance, retiree medical access, and more.

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 belongs.

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

We anticipate the application window for this opening will close on: 05/31/2026.