Executive Director, Clinical Health Services - Aetna Specialty Programs

CVS Health•Work At Home-Ohio, OH

2d•$184,112 - $396,550•Remote

About The Position

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.

Requirements

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.
Bachelor's degree required
Active RN license required

Nice To Haves

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

Responsibilities

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.
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.
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.
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.
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.
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.