Executive Director - Clinical Program Operations

CVS Health • New York, MA

1d

About The Position

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: The Executive Director, Clinical Program Operations is a transformative leader responsible for setting and executing enterprise strategy across a dynamic portfolio of clinical programs—including Medication Therapy Management (MTM), Pharmacy Advisor, and Safety & Quality Management (SQM)—at a time of significant industry evolution. As The Centers for Medicare & Medicaid Services’ (CMS) program requirements and regulations continue to evolve, this executive will architect and deliver scalable, value-driven business models across these programs to sustain growth, operational excellence, and best-in-class clinical outcomes. The Executive Director is accountable for program operations with oversight on growing annual operating expense of $53M+ and revenue stream of $210M+ as well as quality, innovation, and execution on client commitments and partnership. The Executive Director owns the MTM Product’s maintenance and value growth as well as people leadership across a diverse operations team. The team is focused on delivery of multi-dimensional counseling and medication therapy enhancements that promote health outcomes for the members we serve. The Executive Director will lead a large team of 200-250 total colleagues. The leadership team is made up of four Senior Managers (two reporting as directs), three Managers, three Professional Support Pharmacists, and nine Supervisors. MTM is a required and high-touch Medicare program, also adopted by some Commercial clients, expected to grow significantly in 2027. This leader will be responsible for continued, transformational expense reduction to ensure affordability, sustainability, and growth for our health plans while maintaining compliance and member value. The Executive Director will oversee a multi-faceted strategic roadmap focused on value-delivery and will own one or more vendor relationship(s) focused on program delivery, contract & pricing optimization, and throttling delivery channels to balance cost with completion rates. Pharmacy Advisor has many Commercial clients and is evolving as a Medicare Stars measure program that includes Integrated STARS Solutions (ISS). Poly-Anticholinergics (Poly-ACH) & Concurrent Use of Opioids and Benzodiazepines (COB) programs continue to expand. This leader will build on the organization’s recent, measurable success in improving plan STAR ratings, driving ongoing progress and impact for clients and members. The SQM program execution impacts millions of members annually to deliver optimal medications therapies, and the team is advancing a system strategy culminating in a new platform launch throughout 2026. The Executive Director will partner closely with Product and Operations Technology leaders to modernize the platform and operational execution. The Executive Director champions operational rigor, complex collaboration across enterprise business units, continuous improvement, and consultative leadership—ensuring the organization leads the field in value-based care and technology-enabled transformation.

Requirements

• 15+ years of progressive operational leadership in a clinical setting, with a demonstrated track record of strategic transformation, financial management, and operational excellence in large, complex healthcare organizations.
• Expertise in MTM and other government-sponsored clinical programs preferred, including deep familiarity with CMS rules, regulations, and Star measures.
• Proven ability to architect and scale new business models, drive measurable improvements in cost, quality, and client value, and consult with clients to design and optimize clinical programs.
• Exceptional business acumen and analytical skills; ability to leverage data to inform strategy, monitor performance, and drive executive decision-making.
• Outstanding executive presence, influence, and communication skills; able to engage credibly with senior leaders, clients, regulators, and cross-functional partners.
• Experience leading large, multi-site or remote teams, including recruitment, development, and retention of high-performing clinical operations talent.
• Strong project/change management and cross-functional collaboration skills.
• Advanced clinical degree (PharmD, BS Pharmacy), degree in healthcare administration, MBA or related fields preferred or relevant professional experience required

Nice To Haves

• Deep expertise in Medicare Part D clinical operations, including MTM program design, Stars measure strategy, and CMS audit readiness across large, complex operational environments.
• Proven success leading technology‑enabled operational transformation, including platform modernization, workflow redesign, vendor optimization, and large‑scale change management.
• Demonstrated track record of driving measurable improvements in quality, cost, and client outcomes through data‑driven decision making, advanced analytics, and operational rigor.
• Experience serving as an executive‑level clinical partner to health plans or large employer clients, including presenting to senior stakeholders, influencing regulatory strategy, and shaping client‑facing clinical program roadmaps.

Responsibilities

• Strategic Leadership & Transformation: Develops and executes the vision and strategy for all clinical program operations (MTM, Safety & Quality Management, Pharmacy Advisor, and others), anticipating and responding to CMS requirements, Star measures, and emerging market/client needs.
• Business Model Innovation: Architect and implement scalable, value-driven business models for all programs—reducing per-unit costs, increasing operational efficiency, and positioning the organization for growth as CMS and market forces evolve.
• Financial & Operational Oversight: Lead multi-million-dollar operating budgets and grow multi-million dollar revenue streams ensuring performance at or below budget, achievement of client guarantees, elimination of financial and compliance risks, and growth of client value.
• MTM Vendor Partnership & Optimization: Oversee the relationship with the MTM program vendor, including contract negotiation, pricing optimization, operational delivery, and strategic alignment of delivery channels to manage cost and completion rates.
• Client Partnership & Consultative Growth: Serve as executive clinical partner for clients, account teams, and enterprise stakeholders—driving program implementations, adoption, client-specific strategy, and consultative support that differentiates the organization in the market. Lead high-stakes client and CMS discussions, address clinical and operational inquiries, and advocate for program enhancements.
• Team Leadership & Talent Development: Lead, inspire, and develop a high-performing, multi-level team (including senior managers, managers, advisors, and 200+ front-line colleagues)—fostering innovation, accountability, and a culture of engagement and inclusion.
• Quality, Compliance & Audit Excellence: Ensure full compliance with CMS, state, and federal regulations; oversee all audit activities (internal, mock, accreditation, and CMS), aiming for zero findings and flawless reporting.
• Data-Driven Performance Management: Leverage operational dashboards, analytics, and best practices to drive measurable outcomes, continuous improvement, and executive-level reporting to senior leadership and clients.
• External Advocacy & Industry Engagement: Represent the organization as an industry thought leader—engaging with CMS, clients, and the broader healthcare ecosystem to shape policy, share insights, and drive best-in-class standards for clinical program administration.
• Technology & Platform Transformation: Partner with operations technology leaders to drive the successful launch, adoption, and user change management of new clinical program platforms (targeting late 2026), ensuring alignment of operations, technology, and business strategy for future growth and efficiency.
• Member/Patient Impact: Drive the development and execution of innovative member engagement strategies, achieving clinical outcomes and client performance goals that positively impact the health and experience of millions.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager