VP, Clinical Insights, Innovation, & Policy - Aetna

CVS Health•Hartford, CT

1d•Remote

About The Position

The Vice President, Clinical Insights, Innovation, & Policy is the senior leader accountable for how Aetna Clinical Solutions turns clinical insight and strategy into action. This role brings together clinical insights, medical policy operations, clinical value strategy, and innovation into one integrated organization. It combines the former Clinical Insights & Innovation and Clinical Value & Policy responsibilities to ensure clinical strategy, care model execution, and medical policy are aligned and consistently applied across ACS. The VP focuses on improving outcomes, managing medical cost trends responsibly, and ensuring regulatory and clinical integrity, while making innovation practical, scalable, and embedded into day‑to‑day care delivery.

Requirements

15+ years of progressive leadership experience in healthcare, with accountability for clinical strategy, policy, innovation, or medical cost management
Previous experience leading and partnering with clinicians.
Experience in multi‑line health plan environments (e.g. Medicare, Medicaid, Commercial)
Strong understanding of medical policy, utilization management, regulatory requirements, and care model design.
Proven ability to lead large, complex teams and influence senior stakeholders across clinical, financial, and operational functions.
Experience integrating analytics, innovation, and policy into scalable clinical operations.
Proven experience leading and developing talent

Nice To Haves

Clinical degree (e.g., MD, DO, RN, PharmD) would be valued but not required
Value Based Care knowledge will be highly valued

Responsibilities

Set and lead the clinical insights and innovation strategy for ACS, translating data, trends, and evidence into clear priorities and actions.
In partnership with Medical Affairs, design, test, and scale innovative care models and clinical programs that improve member outcomes, experience, and operational efficiency.
Operationalize medical policy and ensure consistent and timely implementation of medical policy updates.
Lead total cost of care and utilization strategies for ACS, including Scoreable Action Items (SAIs) and affordability programs, with measurable impact on medical cost performance.
Provide oversight of provider delegation, ACOs, Joint Ventures, and clinical vendors, holding partners accountable for quality, utilization, and performance outcomes.
Ensure regulatory compliance, clinical integrity, and alignment to enterprise and external standards across policies, care models, and innovation efforts.
Partner closely with Clinical Care Delivery, Utilization Management, Finance, Network, Medical Affairs, and enterprise teams to align policy, strategy, and execution.