Executive Director Clinical Health Services

At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven 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

At Aetna our health benefits business we are committed to helping our members achieve their best health in an affordable convenient and comprehensive manner. Combining the assets of our health insurance products and services with CVS Healths unrivaled presence in local communities and their pharmacy benefits management capabilities were joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.

Aetna is recruiting for an Executive Director Clinical Health Services who will be a critical leader in the care management organization responsible for leading and overseeing clinical strategy and operations that support clinical operations across the enterprise. This role will have strategic direction and oversight for the daytoday operations across multidisciplinary teams that support our members in government programs. Teams will primarily be clinical organized by territory and consist of Care Management Consultants (RN) reporting into appropriate levels of clinical leadership.

You will make an impact by:

• Executing the strategic agenda for clinical management supporting populations in our government programs.

• Analyzing and supporting utilization management performance of all relevant models and business lines meeting all clinical business and performance goals.

• Identifying gap needs and implements strategies to improve outcomes and member/provider experience.

• Leading health strategies tactics policies and programs that ensure appropriate utilization and cost savings.

• Partnering and collaborating with business leaders internal/external customers regulators and consultants to improve outcomes.

• Overseeing and ensuring compliance with all applicable Federal and State regulations relevant to the plans function.

• Working in close alignment with executive leaders as well as with matrixed quality care management program design and external and internal business partners/vendors/consultants.

• Managing budget and staffing with membership movement and staffing ratio movement across lines of business.

• Developing and overseeing the implementation of staffing models that are consistent cost effective and meet all compliance obligations.

• Leading developing motivating recognizing and managing highperforming teams to meet organizational goals and objectives while effectively managing change.

• Building an environment that supports professional development mobility and operational excellence.

• Fostering a culture that accelerates our strategy through our HeartAtWork Behaviors by keeping the customer and colleague as the central focus.

• Supporting CVS Health in attracting retaining and engaging a diverse and inclusive consumercentric workforce that delivers on our purpose and reflects the communities in which we work live and serve.

Required Qualifications

The candidate will have a strong work ethic be a selfstarter and be able to be highly productive in a dynamic collaborative environment. This position offers broad exposure to all aspects of the companys business as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 1015 years of experience leading complex teams with knowledge of the healthcare system including managed care operations.

• Unrestricted RN license in good standing.

• Comprehensive knowledge of utilization management to improve quality of care and reduce costs including core operations network management provider relations and medical management/care management.

• Strong data and analytics skills to include modeling synthesizing information and deriving key insights.

• Expertise within clinical and health plan operations including Policy Management Care Management and Coordination Quality Compliance and Regulatory Management.

• High ability to drive new strategies or initiatives in highly crossfunctional environments.

• Expertise with influencing and navigating a highly matrixed environment.

• Effectively lead and motivate teams to ensure high standards of performance and outcomes.

• Experience in effectively simplifying and presenting complex information.

• Strong analytical and critical thinking skills. Focus on driving disciplined factbased decisions and executing with discipline and urgency.

• Success in moving from current traditional strategies to new modified approaches championing change.

• Demonstrate a commitment to diversity equity and inclusion through continuous development modeling inclusive behaviors and proactively managing bias.

Education
Bachelors degree required.

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual fulltime 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 shortterm incentive program in addition to the base pay range listed above. This position also includes an award target in the companys 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.

• Nocost 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 anticipate the application window for this opening will close on: 04/14/2025

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