Executive Director, Clinical Services Operations - PBM

CVS Health•St. David's, CT

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 CVS Caremark is the nation's leading pharmacy benefit manager (PBM). We work to ensure the path to better health is affordable, easy to access, and simple to follow, for our 103 million plan members. We provide personalized support to help people start and stay on their medications, because people who take their medications have better outcomes and lower health care costs. CVS Caremark is recruiting for an Executive Director, Clinical Services Operations for the PBM Client Services and Support teams. This transformational leader is responsible for providing strategic leadership over Prior Authorization (PA) Administration across three platforms, PA Client Liaisons, Clinical Implementation for Non-Adjudication Programs, Business Innovation and Intelligence, Service Warranty and Performance Guarantee Management. As PBM delivery and client needs evolve, this leader will architect and deliver scalable, value-driven solutions that support client needs and compliance with regulatory and accreditation standards while sustaining growth, operational excellence, and best-in-class clinical outcomes. The Executive Director is accountable for annual operating expense of $43M, oversees a Performance Guarantee budget of $600K, and a Service Warranty budget of $1.7 against a large risk portfolio. The PA Administration team is responsible for the oversight and delivery of end-to-end client configuration and fulfillment delivery to enable prior authorization delivery. The team oversees >300 implementations and 10,000 maintenance cases annually. The PA Client Liaisons are responsible for engaging directly with clients and operations to coordinate delivery of Prior Authorization solutions, through configuration, technology, or process, in collaboration with the broader Clinical Operations team. The Clinical Implementation for Non-Adjudication Programs team is responsible for the oversight and delivery of program setup for PBM clients, which contributes significant revenue. The Service Warranty, Performance Guarantee and Contracting Oversight team is the single point of contact to ensure contracts and financial agreements align with operational capabilities. The team is also responsible for identifying controls and improvements to reduce service warranty and performance guarantee payouts. The Business Innovation and Intelligence team identifies solutions to complex problems that improve quality and compliance while reducing busy work. The Executive Director champions operational rigor, complex collaboration across enterprise business units, continuous improvement, and consultative leadership—ensuring the organization leads in customer-centricity and technology-enabled transformation.

Requirements

The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment.
This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders.
The candidate will be expected to have the following key attributes:
15 years of progressive leadership, with a demonstrated track record of strategic transformation, financial management, and operational excellence in large, complex healthcare organizations.
Proven ability to architect and scale new business models, drive measurable improvements in cost, quality, and client value, and consult with clients and operations to design and optimize delivery.
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.

Responsibilities

Strategic Leadership & Transformation: Set the vision and strategy for Clinical Operations Client Services and Support, anticipating and responding to operational, client, compliance, and emerging market needs.
Business Model Innovation: Architect and implement scalable, value-driven business models for all teams that result in operational per-unit cost reduction, higher compliance, and greater client satisfaction.
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.
Business Partnership & Optimization: Oversee the relationship with several CVS Health partners, including Medical Affairs, Product, Trade, Sales and Account Services, Aetna, and others.
Client Partnership & Consultative Growth: Serve as executive partner for clients, account teams, and enterprise stakeholders—driving implementations, client-specific strategy, and consultative support that differentiates the organization in the market.
Team Leadership & Talent Development: Lead, inspire, and develop a high-performing, multi-level team (including senior managers, managers, advisors, and 350+ colleagues)—fostering innovation, accountability, and a culture of engagement and inclusion.
Vendor Management: Oversight and management of offshore vendor staff that support configurations while maintaining compliance with client contracts.
Data-Driven Performance Management: Leverage dashboards, analytics, and best practices to drive measurable outcomes, continuous improvement, and executive-level reporting to senior leadership and clients.
Technology & Platform Transformation: Partner with operations technology leaders to drive the successful launch, adoption, and user change management of platform transformation, ensuring alignment of operations, technology, and business strategy for future growth and efficiency.

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.

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