VP, Chief Operating Officer, Medical Affairs - Aetna

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, 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 Aetna is seeking to hire a VP, Chief Operating Officer for Medical Affairs with deep experience in enterprise‑level clinical operations. Reporting directly to Aetna’s Senior Vice President & Chief Medical Officer, this senior executive will serve as the primary operational leader overseeing all core Aetna Medical Affairs functions, including utilization management, appeals, care management, care model design, clinical pathways, Network/Provider Engagement and clinical enablement programs. The VP, COO for Medical Affairs will act as a strategic partner to the CMO‑VPs for Commercial, Medicare and Medicaid as well as to the VP of Utilization Management , ensuring alignment between line‑of‑business strategies and Medical Affairs operations. This leader will also serve as the principal operational interface with ACS and Network leadership to ensure cross‑functional integration, operational readiness, and consistent national execution. The successful candidate will bring an enterprise mindset and the ability to build a unified operating model across Aetna Medical Affairs . Major Responsibilities Enterprise Operational Leadership Serves as a key strategic operational advisor to the Aetna CMO VPs for Commercial, Medicare, Medicaid and Utilization Management, across both physical and behavioral health. Acts as the primary operational liaison with ACS and Network leadership, driving enterprise‑wide alignment on clinical operations, policy, workforce strategy and operating standards. Enterprise Operating Framework & Governance Leads development and continuous evolution of the enterprise Aetna Medical Affairs operating model , spanning utilization management, appeals, care management, care model design, clinical pathways, network alignment and quality programs. Serves as the Med Affairs lead for Aetna enterprise‑wide operating plans , integrating efforts across ACS, Network, Technology, Analytics and business‑unit clinical leadership. Establishes and maintains consistent national operating standards, governance structures and documentation, workflows and performance expectations across all Aetna Medical Affairs programs. Performance Management, Dashboards & Metrics Designs and oversees dashboards, KPIs and scorecards for all Aetna Medical Affairs functions. Leads the strategy and execution of enterprise reporting, ensuring standardized, accurate and actionable data for leadership and key stakeholders. Establishes performance review structures, operational early‑warning systems and transparent reporting mechanisms for Aetna Medical Affairs leadership and line‑of‑business partners. Partners closely with analytics and technology teams to leverage data, insights and automation to improve outcomes and clinical decision‑making. Workforce Management, Planning & Operational Excellence Provides oversight for Aetna Medical Affairs workforce management strategy, including capacity planning, staffing models, productivity optimization and resource allocation. Leads integrated workforce planning to ensure alignment with business demand, regulatory requirements and performance expectations. Drives operational excellence through continuous process improvement, workload balancing and optimization of clinician and operational team performance. Financial & Resource Management Oversees Aetna Medical Affairs budget planning, forecasting and financial performance management. Partners with finance and business leaders to ensure transparency, accountability and alignment between financial performance and operational outcomes. Drives disciplined investment prioritization and cost management to support operational efficiency and value creation. Ensures resources are deployed efficiently and investments support operational and performance goals. Project Management Office (PMO) Leadership Provides executive oversight for a centralized Medical Affairs Project Management Office, ensuring disciplined execution of strategic initiatives. Establishes standardized project management methodologies, governance and reporting to drive visibility and accountability. Ensures alignment and prioritization of key initiatives across Medical Affairs and enterprise partners. Clinical Quality, Audit & Decision Excellence Leads enterprise strategy and oversight for clinical quality, ensuring consistent, evidence‑based medical decision‑making across all lines of business. Oversees audit functions, quality review processes and governance frameworks to strengthen accuracy and compliance. Drives continuous improvement in clinical decision quality through analytics, feedback loops and targeted interventions. Partners across Medical Affairs, ACS and Network to ensure alignment on quality standards, audit outcomes and performance expectations. Cross‑Functional Operations & Execution Leads end‑to‑end operational integration across Aetna Medical Affairs, ACS, Network, Technology, Analytics and business‑unit clinical teams. Oversees national operations including ~60 direct‑team FTE and 300+ transactional clinicians. Drives technology‑enabled operational transformation, including modernization through automation, AI‑enhanced workflows and data‑driven operating models. Provides strategic thought leadership to the SAI process to identify key operational improvements and guide enterprise‑aligned solutions. Qualifications 15+ years of progressive experience and responsibility at a senior leadership level in managed healthcare operations or a related field. Deep understanding of utilization management and its impact on healthcare quality and total cost of care. Deep understanding of clinical/claims systems and processes. Deep understanding of compliance and quality programs (e.g., NCQA, HEDIS). Experience addressing issues impacting member and provider experience. Demonstrated ability to work collaboratively across functions to align on shared goals, integrated processes and KPIs. Proven leadership in business process optimization, cross‑functional integration, strategic operational planning and risk management. Ability to leverage the emerging healthcare environment to create platforms for change. Strong analytical and problem‑solving skills and a data‑driven approach to decision‑making. Ability to thrive in a fast‑paced, dynamic environment and manage multiple priorities effectively. Education Degree, certification or equivalent experience in healthcare or health plan operational management. An advanced degree in healthcare administration or business administration is a plus. Core Competencies Able to navigate a complex organization: Work effectively in a large, multifaceted organization and influence senior management enterprise‑wide. Highly skilled communicator with the ability to connect deeply with people: Excellent communication skills, clear presentation, good listening and credibility to win support. Demonstrate excellence and accountability: Innovate, anticipate the future and drive continuous improvement. Deliver quality service and value: Build trust, create value‑added relationships and exceed expectations. Lead change: Inspire others, communicate a compelling vision and embrace change effectively. Drive for results: Focus on outcomes, take initiative and marshal resources to get things done. Build colleague engagement: Encourage independent thinking, value diversity and celebrate successes. Pay Range $250,000 - $350,000 Great benefits for great people This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional and financial well‑being of colleagues and their families. Benefits include medical, dental and vision coverage, paid time off, retirement savings options, wellness programs and other resources, based on eligibility. We anticipate the application window for this opening will close on: 07/13/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr