VP, Clinical Operations

CVS Health•Chicago, IL

1d•$240,000 - $300,000•Onsite

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. The Vice President, Clinical Operations is a transformative operations leader responsible for providing strategic leadership, clinical oversight, and executing enterprise strategy across a dynamic portfolio of clinical programs—including Prior Authorization and Appeals, Medication Therapy Management (MTM), Pharmacy Advisor, and Safety & Quality Management (SQM)— at a time of significant industry evolution. This executive will architect and deliver scalable, value-driven business models across these programs to sustain growth, operational excellence, and best-in-class clinical outcomes. Lines of business include Medicare, Medicaid, Commercial, Individual Exchange, and Commercial Specialty across pharmacy and medical benefit. These services represent significant operational expense and revenue, with year over year growth expected. This leader is responsible for planning and executing a strategy that ensures we are achieving the highest levels of efficiency and compliance to deliver best in class member care to our members and clients. This role is responsible for the collaboration with internal business areas such as Client Services, Marketing, Regulatory Affairs, Accreditation, Product, Trade, Pharmacy Operations, Member Operations, Account Management, Finance, DDAT, and support partners to deliver service quality and compliance standards according to CMS, state and federal regulations, URAC and NCQA accreditation standards, and UM goals. The VP will also be a key stakeholder in building a sustainable, scalable operation while delivering on aspirational goals around automation and augmentation, colleague performance, and meeting a demanding market and client landscape. Span of new organization includes 3 Direct Reports, 4,205 indirect reports at peak (full time employees and contingent workers).

Requirements

15+ years of professional experience leading complex customer operations with support to members and clients
15+ years of experience demonstrating the ability to identify and define business problems and opportunities, develop strategic and analytical frameworks to conduct analysis resulting in optimal operational efficiencies
Organize, prioritize, and manage multiple tasks on a regular basis with elevated level of detail
Superior Oral and Written communication skills
Proven development of teams and skill building competencies
Strong Customer Service orientation both internally and externally
Experience in Change Management practices
Demonstrates resourcefulness in complex problem-solving
Displays confidence and aptitude to digest complex material and provide timely solutions
Proficient computer knowledge including Microsoft office products and Windows based operations

Nice To Haves

10+ years of experience within a Pharmacy Benefit Management
Pharmacy license preferred but not required

Responsibilities

Provides executive leadership for a large, complex organization, establishing the vision, strategy, and operating framework necessary to achieve enterprise and business objectives.
Builds a high-performing leadership team focused on operational excellence, organizational effectiveness, talent development, and sustained business results.
Cultivates strong cross-functional partnerships to address enterprise opportunities, enhance member outcomes, and drive strategic alignment across the organization.
Shapes and influences the strategic direction of Clinical Operations and key enterprise initiatives.
Partners with senior executives to identify opportunities for innovation, growth, operational transformation, and competitive differentiation.
Serves as an executive sponsor for critical business initiatives, ensuring organizational readiness, scalable execution, and alignment with enterprise priorities while fostering a culture of innovation, accountability, and continuous improvement.
Maintains ultimate accountability for organizational performance, including financial management, operational results, member and client experience, and achievement of strategic business objectives.
Drives sustainable growth, operational excellence, and continuous improvement through disciplined execution, data-driven decision-making, and effective allocation of organizational resources.
Ensures delivery of measurable value to members, clients, and the enterprise.
Provides executive oversight for all operational functions, ensuring strategic priorities, organizational capabilities, and operating models support current and future business needs.
Balances enterprise transformation efforts, client commitments, and operational performance while driving efficiency, scalability, and innovation.
Ensures execution excellence and organizational adaptability without compromising service quality or member experience.
Champions CVS Health’s Ambition, Purpose and Values in the experience of our members, clients, and colleagues.
Establishes a member-centric culture that reinforces accountability, engagement, and service excellence at every level of the organization.
Ensures leaders understand the direct connection between colleague experience, organizational culture, operational performance, and member outcomes.
Serves as a trusted advisor and influential executive leader, effectively communicating business strategy, organizational priorities, and transformation initiatives to internal and external stakeholders.
Demonstrates executive presence and strategic acumen while building credibility with enterprise leaders, clients, and key partners.
Translates complex business challenges into clear direction, enabling alignment, engagement, and successful execution across the organization.