Executive Director, Clinical Health Services - Aetna Specialty Programs

Position Summary 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. 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 in Aetna Specialty Programs. This critical leader will oversee enterprise clinical strategy and operations that drive high‑quality care management, exceptional member experiences, and strong clinical outcomes for Specialty programs such as maternity, cardiac, musculoskeletal, oncology, and pharmacy. 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 strategies supporting Commercial Care and Specialty Operations, including specialty programs such as maternity, cardiac, musculoskeletal, oncology, and pharmacy. Oversee day‑to‑day operations for multidisciplinary care teams, ensuring consistent, high‑quality clinical practices and service delivery. Lead organizations of up to 600 clinical and non‑clinical staff within a call center environment, with accountability for call center performance metrics and outbound member engagement strategies. 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 10+ years of progressive experience in clinical care management, population health, or utilization management; unrestricted RN license in good standing. 5+ years of senior leadership experience overseeing large, multidisciplinary clinical teams, including call center operations. Proven ability to lead large, complex organizations of up to 600 FTEs in fast‑paced, matrixed environments, with accountability for quality, utilization, outcomes, and financial performance. Experience leading large‑scale care management programs (case, disease, and complex care management) across commercial populations. Expertise overseeing specialty clinical programs, including maternity, cardiac, musculoskeletal, oncology, and/or pharmacy. Strong track record of driving innovative, data‑driven strategies to improve member engagement, experience, and outcomes, including the use of AI‑enabled tools and advanced technologies. Deep knowledge of health plans and clinical operations, including care management, quality, compliance, policy, and regulatory requirements. Advanced analytical and strategic skills, with the ability to evaluate cost‑benefit tradeoffs, translate insights into action, and drive continuous improvement. Demonstrated success influencing across cross‑functional teams and external partners, with the ability to communicate complex information clearly and effectively. 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 Bachelor's degree required. Active RN license required. Travel 25% travel. Pay Range The typical pay range for this role is: $184,112.00 - $396,550.00. 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. Benefits Full‑time position eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr 4062 Aetna Resources, LLC