Lead Director - Clinical Innovation, Analytics Delivery

CVS Health•Work At Home-Connecticut, CT

1d•$100,000 - $231,540

About The Position

The Lead Director, UM Innovation & Strategic Analysis is a leadership role within Aetna’s Clinical Solutions business unit, responsible for defining and driving the strategic analysis portfolio, enterprise transformation priorities, and Utilization Management (UM) automation strategy. The role advises senior leadership and identifies opportunities to improve clinical, operational, and financial performance through data-driven insights, market intelligence, business cases, and technology-enabled innovation. The position evaluates emerging trends, competitive dynamics, and operational performance to identify opportunities that create enterprise value and strengthen Aetna’s competitive position. Working across clinical, operational, product, and technology organizations, the Lead Director drives analysis, portfolio prioritization, and business transformation, with a focus on modernizing UM through automation, artificial intelligence, and digital innovation. The role is accountable for measurable outcomes through effective governance, value realization, and execution of strategic initiatives. The leader also manages and develops a high-performing team through coaching, mentoring, and professional development, while fostering innovation, accountability, and continuous improvement.

Requirements

10+ years of experience leading strategic planning, business analysis, consulting, portfolio management, transformation, or innovation initiatives within healthcare, health insurance, or managed care organizations.
Deep understanding of health plan operations, including Utilization Management, Policy Management, Care Management, Quality, Compliance, Regulatory Management, Claims, and Provider Networks.
Demonstrated experience developing and leading enterprise strategic initiatives from concept through implementation and value realization.
Strong analytical and problem-solving skills, including business modeling, financial analysis, data synthesis, and development of executive-level recommendations.
Proven success in enterprise portfolio management, strategic planning, and prioritization of complex initiatives.
Experience with data visualization tools and advanced analytics technologies, including SQL, Python, and cloud-based data platforms.
Strong understanding of automation, AI-enabled workflows, digital transformation, and technology-driven operational improvement.
Expertise in developing business cases, defining success metrics, and measuring return on investment for strategic initiatives.
Strong interpersonal and communication skills, with the ability to influence senior leaders and key stakeholders.
Bachelor’s degree or equivalent work experience.

Nice To Haves

5+ years of leadership experience in innovation, advanced analytics, business process optimization, enterprise consulting, strategic planning, financial analysis, risk management, or related disciplines.
Experience creating new capabilities, products, services, operating models, or automation solutions that deliver measurable business value.
Experience with Utilization Management modernization, intelligent workflow automation, and operational transformation initiatives.
Knowledge of Generative AI, machine learning, natural language processing, decision engines, APIs, workflow orchestration platforms, and predictive analytics.
Executive-level relationship management skills and ability to influence without direct authority.
Experience managing enterprise-wide portfolios and complex, strategically important cross-functional initiatives.
Strong conceptual and structured thinking skills and ability to translate ideas into actionable strategies and operational outcomes.
Ability to navigate ambiguity, shifting priorities, and evolving business needs while maintaining focus on results.
Health domain certifications such as AHIP certifications (Fundamentals of Healthcare Part A & B, AHM250).
Master’s degree.

Responsibilities

Evaluate Utilization Management performance, market trends, regulatory developments, and emerging technologies to identify opportunities to improve clinical outcomes, operational efficiency, administrative burden, and business value.
Lead strategic analyses, business cases, and investment recommendations to shape UM strategy, prioritize transformation initiatives, and inform executive decisions.
Drive strategic portfolio planning for UM modernization, including opportunity assessment, prioritization, resource alignment, funding recommendations, and value realization tracking.
Partner with Clinical Operations, Product, Technology, and Enterprise Innovation teams to define and execute a multi-year UM modernization roadmap aligned with business priorities and customer needs.
Identify, evaluate, and implement UM automation opportunities using AI, Generative AI, predictive analytics, NLP, business rules engines, and decision support technologies.
Develop and monitor KPIs, dashboards, and measurement frameworks to assess the impact of automation and transformation on productivity, service levels, quality, provider and member experience, and operating costs.
Provide strategic oversight and governance for innovation pilots, proof-of-value assessments, and transformation initiatives, ensuring scalability, business alignment, and achievement of targeted outcomes.
Build influential relationships across the organization and advise senior leaders on UM strategy, operational performance, automation opportunities, and enterprise transformation priorities.
Manage and develop a high-performing team through coaching, mentoring, and professional development, fostering innovation, accountability, and continuous improvement.