Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health(R), you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.**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 Health’s unrivaled presence in local communities and their pharmacy benefits management capabilities, we’re joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.Aetna is seeking an Executive Director, Clinical Health Services for Aetna Clinical Solutions. This critical leader will oversee enterprise clinical strategy and operations that drive high‐quality care management, exceptional member experiences, and strong clinical outcomes. The Executive Director provides strategic direction, operational leadership, and day‐to‐day oversight of multidisciplinary teams of clinicians and support staff.This role partners closely across the enterprise—clinical teams, quality, operations, program design, finance, and external healthcare partners—to deliver coordinated care, ensure regulatory compliance, optimize utilization, and advance organizational goals.**Key Responsibilities****Strategic & Operational Leadership*** Lead the development and execution of clinical strategy supporting Commercial Care and Specialty Operations.* Oversee daily operations for multidisciplinary care teams, ensuring consistent, high‐quality clinical practices and service delivery.* Develop and implement staffing models that are cost‐effective, compliant, and aligned with membership and business needs.* Manage budget, staffing, and operational performance across lines of business.**Clinical Excellence & Care Coordination*** Collaborate across departments to support comprehensive member care, including assessments, care planning, coordination with providers, and continuous monitoring to improve outcomes.* Guide teams to advocate for members, ensuring effective communication, resource utilization, and overall well‐being.* Direct implementation of care models, workflows, and procedures that ensure high‐quality, evidence‐based care.* Conduct and oversee clinical record reviews to ensure documentation quality and timeliness.**Performance, Utilization, and Quality*** Monitor and analyze performance of utilization management and care management programs; implement strategies to improve outcomes and experience.* Identify operational gaps and lead initiatives to enhance efficiency, clinical quality, and member and provider satisfaction.* Ensure compliance with all applicable federal and state regulations.**Cross‐Functional Partnership & Stakeholder Engagement*** Partner with executive leaders, internal teams, regulators, consultants, and external stakeholders to advance clinical and operational objectives.* Maintain relationships with community health providers, ambulatory partners, and population health organizations to support coordinated care across the continuum.* Represent the organization in key meetings and with external agencies, including governmental and payer entities.**People Leadership & Culture*** Lead, develop, mentor, and inspire high‐performing teams through coaching, recognition, and effective change leadership.* Build an environment that supports professional development, mobility, and operational excellence.* Foster a culture grounded in CVS Health’s Heart‐At‐Work Behaviors with a strong focus on members and colleagues.* Support recruitment, retention, and engagement of a diverse, inclusive workforce reflective of the communities we serve.**Program Strategy & Standardization*** Partner with Clinical Health Services leadership to advance standardized practices for care transition management and enterprise clinical operations.* Define training strategies for clinical and program staff to support consistent, high‐quality practices.* Lead annual goal‐setting and operational planning aligned with Clinical Health Services and organizational priorities.**Required Qualifications**The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:* 10+ years progressive experience in clinical care management, population health, or utilization management.* Unrestricted RN license in good standing.* 5+ years of senior leadership overseeing multi‐disciplinary clinical teams.* Demonstrated success leading large‐scale care management programs (case, disease, and complex care management).* Experience with commercial populations (employer‐sponsored insurance) strongly preferred.* Proven accountability for clinical outcomes, utilization management, and financial performance.* Strong relationship‐building experience with external clients, including plan sponsors and consulting firms.* Expertise in program strategy, including planning, executing, and optimizing strategic initiatives.* Deep knowledge of improving quality of care and reducing costs across operations, network management, provider relations, and care/medical management.* Strong analytical and data capabilities, including modeling, synthesizing information, and deriving actionable insights.* Expertise in clinical and health plan operations, including Policy Management, Care Management, Quality, Compliance, and Regulatory Management.* Proven ability to drive new strategies and lead initiatives in cross‐functional, matrixed environments.* Skilled in leading, influencing, and motivating teams to achieve high performance and outcomes.* Adept at simplifying and communicating complex information to diverse audiences.* Strong critical thinking, disciplined decision‐making, and focus on timely execution.* Demonstrated experience transitioning from traditional approaches to innovative strategies and championing change.* Effective problem‐solving abilities and strong organizational, multi‐tasking, and adaptability skills.* Skilled in tactful communication with customers, community stakeholders, and clinical staff.* Ability to evaluate cost‐benefit impacts to inform sound decisions.* Experience working within clinical settings and across diverse cultural dynamics of staff and patients.* Knowledge of care transitions and available patient resources.* Digital literacy with the ability to manage sensitive information ethically and responsibly.* **Open to remote work arrangements across the U.S.****Preferred Qualifications*** Certification in Case Management (CCM, ACM) or related population health credentials.* Experience integrating or overseeing digital health or vendor‐based care solutions.* Background in enterprise clinical transformation or population health strategy.**Education** Master’s Degree preferred. Active RN license required.**Travel**25%**Pay Range**The typical pay range for this role is:$184,112.00 - $396,550.00This 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 #J-18808-Ljbffr

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