Principal Clinical Leader - Aetna Commercial CM and UM Operations - RN

CVS Health•Work At Home-Connecticut, CT

4d•$121,514 - $261,723•Remote

About The Position

This Principal Clinical Leader role is responsible for directing Care Management and Utilization Management operations for the Commercial line of business, supporting multiple dedicated plan sponsor populations. The position provides strategic oversight of clinical operations, client relationship management, operational performance, and program execution while serving as a key liaison between internal stakeholders and external clients. The leader is accountable for achieving clinical, operational, financial, and customer experience outcomes through effective team leadership, data-driven decision-making, and strong partnership with plan sponsors and enterprise business partners.

Requirements

Active, unrestricted RN license in state of residence
10 years relevant work experience
Minimum 8 years of progressive clinical leadership experience, including managing teams and other leaders
Leadership experience in Case Management and/or Utilization Management, primarily within Commercial Lines of Business
Strong understanding of Commercial healthcare benefits, employer-sponsored health plans, utilization management processes, population health strategies, and value-based care principles.
Experience leveraging clinical and operational data to identify trends, develop actionable insights, and drive improvements in quality, member experience, utilization, and cost outcomes.
Experience driving performance across complex operations through the use of analytics, performance management frameworks, continuous improvement methodologies, and workforce optimization strategies.

Nice To Haves

At least 3 years of recent experience as a manager at Aetna
Experience supporting national employer groups, Fortune 500 clients, or large-scale Commercial populations is highly desirable.

Responsibilities

Lead and oversee Care Management and Utilization Management operations within the Commercial line of business, ensuring delivery of high-quality, member-centered clinical programs that meet organizational and client expectations.
Provide strategic and operational leadership for multiple dedicated plan sponsor populations, ensuring program performance, service excellence, regulatory compliance, and achievement of clinical, financial, and contractual objectives.
Drive performance across a diverse team of clinical and operational leaders through effective goal setting, performance management, coaching, workforce planning, and continuous improvement initiatives.
Serve as the primary operational leader supporting assigned Commercial plan sponsors, fostering strong relationships and acting as a trusted partner to internal and external stakeholders.
Represent the organization in external client meetings, health plan sponsor reviews, finalist presentations, performance discussions, and strategic planning sessions.
Collaborate with Account Management, Sales, Product, Clinical, and Operations partners to develop and execute client-specific strategies that improve member outcomes, engagement, affordability, and satisfaction.
Oversee delivery of Utilization Management activities, ensuring compliance with regulatory, accreditation, contractual, and quality standards while promoting appropriate, evidence-based care.
Direct Care Management program strategy and execution across complex populations, including management of clinical interventions, member engagement approaches, care planning, and outcomes measurement.
Monitor and drive achievement of key performance indicators including engagement, quality outcomes, utilization trends, financial performance, productivity, customer experience, and service level agreements.
Utilize data analytics and performance insights to identify opportunities, implement corrective actions, and drive operational excellence across teams and client populations.
Lead organizational change initiatives, workforce transformation efforts, and implementation of new programs, technologies, workflows, and clinical capabilities.
Partner closely with plan sponsors and senior leadership to understand business objectives, proactively address emerging needs, and ensure alignment between operational execution and client expectations.