Executive Director, Credentialing, Contract and Compliance Operations

CVS Health • Hartford, CT

6d • Hybrid

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. Executive Director, Credentialing, Contract and Compliance Operations 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. Position Summary The Executive Director, Credentialing, Contract & Compliance Operations is accountable for the enterprise strategy, governance, and execution of Credentialing Verification Organization (CVO) operations, Contract Operations, and Compliance across Commercial, Medicare, and Medicaid lines of business. This role holds end‑to-end accountability for credentialing integrity, contractual accuracy, and regulatory compliance, ensuring the maintenance of a compliant provider network with no material gaps or risk exposure. Accountabilities include oversight of production delivery, quality and compliance outcomes, audit readiness, internal controls, reporting, monitoring, and continuous improvement. The role ensures provider data accuracy, contract configuration and execution, and consistent application of credentialing and compliance policies across the enterprise. The Executive Director operates within a highly regulated environment and partners closely with Legal, Compliance, Network, Quality Management, Finance, and other enterprise stakeholders to deliver required regulatory, operational, service, and financial outcomes.

Requirements

• 12–15+ years of experience in healthcare operations, provider network operations, credentialing, or provider data management, with demonstrated enterprise‑level accountability and impact.
• Demonstrated executive ownership of credentialing and compliance outcomes, including regulatory adherence, audit performance, and operational risk management.
• Proven experience leading large‑scale, regulated operations, including accountability for production delivery, quality, and compliance outcomes.
• Demonstrated success establishing enterprise governance, internal controls, and standardized execution within complex, highly regulated environments.
• Strong operational expertise, including forecasting, inventory management, capacity planning, and production oversight at scale.
• Advanced working knowledge of business systems, applications, and tools supporting credentialing, provider data, and inventory management
• Proven ability to lead and develop people leaders while driving performance, accountability, and organizational health
• Strong executive presence, sound judgment, and the ability to influence across complex, matrixed organizations
• Bachelor’s degree or equivalent
• Ability to work Hybrid Model in a CVS Health Office
• Ability to travel up to 20% of the time

Nice To Haves

• Experience overseeing vendor partnerships in operations environments is highly valued
• Experience leading multi‑workstream operational change through formal program or project management is highly valued

Responsibilities

• Enterprise Leadership & Governance Establish and maintain the enterprise operating model for credentialing, contract operations, and compliance across all lines of business.
• Retain accountability for credentialing and compliance risk, including audit performance, regulatory adherence, and corrective action oversight.
• Define governance structures, controls, and decision authority to ensure consistent execution and accountability across the enterprise.
• Operational Execution & Compliance Oversight Direct credentialing and contract operations to ensure timely, accurate, and compliant execution at scale.
• Oversee production performance, quality assurance, audit preparation, reporting, and inventory management.
• Design and maintain audit procedures and internal controls supporting regulatory, contractual, and provider data accuracy requirements.
• Ensure consistent execution of policies and procedures, supported by formal documentation and adherence standards.
• Contract Operations Establish and manage enterprise contract operations capabilities, including contract intake, storage, configuration, system loading, and execution.
• Ensure contract operationalization supports Commercial, Medicare, and Medicaid business requirements.
• Process Standardization & Change Management Lead enterprise initiatives to standardize credentialing and contract operations processes across systems and lines of business.
• Reduce defects, rework, and operational variability while maintaining compliance and audit integrity.
• Direct structured change management to support adoption of revised workflows, controls, and operating practices.
• Leadership, Vendor & Financial Management Lead and develop credentialing, contract operations, and compliance leadership teams, including direct oversight of people leaders.
• Oversee vendor strategy and performance, including offshore delivery models, with accountability for quality, capacity, and service outcomes.
• Provide forecasting, inventory, and capacity planning oversight to align resources with business demand.
• Manage resources to meet operational and financial objectives within approved budget parameters.

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: Executive
• Number of Employees: 5,001-10,000 employees