Executive Director, Clinical Health Services

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.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 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 day-to-day operations across multi-disciplinary 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 plan's 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 high-performing 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 Heart-At-Work Behaviors by keeping the customer and colleague as the central focus.
• 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.

• 10-15 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 cross-functional 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, fact-based 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.

• 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.