Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.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 to hire an Assistant Vice President of Clinical Health Operations supporting our Commercial business. This innovative leader will manage a team of approximately 1900 FTE (clinical and non-clinical) who are responsible for supporting over 14M members. This role will lead day to day operations across multiple models at the designated and dedicated levels and involves oversight and strategic direction of multi-disciplinary teams including RN Case Managers, Social Workers, Dietitians, Behavioral Health Specialists, Utilization Management Nurses, Care Management Associates, Health Coaches and Quality Consultants. We are seeking top leadership talent that brings their heart to work every day.You'll make an impact by:
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- Leading and driving the strategic agenda for clinical management operations supporting multiple segments, models, and populations for the respective products.
- Analyzing and supporting the utilization and case management performance of all relevant models and business lines, meeting all clinical goals in quality of care and cost of care as well as hitting financial and Quality targets.
- Responsibility for the performance and quality oversight of each model and roles including external performance.
- Responsibility for identifying gap needs and implementing strategy to improve outcomes and performance needed member/provider experience.
- Leading health strategies, tactics, policies, and programs that ensure appropriate utilization and cost savings.
- Partnering with segment heads, account executives, plan sponsors, and consultants as well as product and design, customer meetings, RFP process, case conferencing, clinical assessments, finalist meetings and strategy to improve outcomes.
- Overseeing and ensuring compliance with all applicable Federal and State regulations relevant to the plan's function.
- Working in very close alignment with other leaders, as well as with matrixed quality, care management, product, program design and external and internal business partners/vendors/consultants.
- Managing budget, staffing with membership movement, and staffing ratio movement across models.
- Build and mentor staff to drive performance in Clinical operations.
- Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
The successful candidate will have a strong work ethic, be a self-starter, and 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 of experience leading in large matrixed organizations.
- 10+ years of managed care experience with understanding of the end-to-end business model and co-dependencies.
- 10+ years of experience in the development and implementation of metrics and analytics to measure performance.
- Clinical licensure and experience.
- The ideal candidate will have a deep understanding of healthcare operations, regulatory compliance and the complexities associated with both and have a clear focus on creating simplicity for our members and providers.
- Travel will be required up to 20% of the time.
- Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
Advanced degree
Education
Bachelor's degreePay Range
The typical pay range for this role is:$227,630.00 - $490,280.00
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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 03/05/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.