VP, Health Plan Quality - Aetna

CVS Health•Hartford, CT

3d•Hybrid

About The Position

The Vice President, Health Plan & Provider Quality provides enterprise leadership for quality performance, regulatory compliance, and accreditation readiness across all Aetna Clinical Solutions lines of business. This role integrates health plan quality, provider quality oversight, and clinical data enablement into a unified quality strategy that improves clinical outcomes, member experience, and external quality performance. The VP is accountable for driving results across HEDIS, CAHPS, Stars, and value‑based arrangements through clinically informed, data‑driven improvement strategies. The role ensures quality standards are consistently applied, performance is transparent and actionable, and ACS maintains strong credibility with regulators, accreditation bodies, providers, and enterprise partners.

Requirements

Active clinical license (RN, MD/DO, NP, or PA) strongly preferred, or equivalent senior‑level clinical quality experience.
15+ years of progressive leadership experience in healthcare quality management, regulatory compliance, and/or clinical performance improvement, preferably in managed care.
Strong expertise in CMS and Medicaid requirements, accreditation standards (e.g., NCQA), and clinical quality measurement frameworks, including HEDIS and Stars.
Executive‑level experience leading enterprise‑scale teams and programs with high regulatory and accreditation visibility.
Proven experience overseeing provider quality, delegated arrangements, and provider‑facing performance improvement initiatives.
Strong background in clinical data, quality analytics, and performance reporting to drive decision making and outcomes.
Demonstrated success leading cross‑functional initiatives and engaging directly with regulators, accreditation bodies, and external partners.

Responsibilities

Define and lead the enterprise quality strategy for ACS, aligning clinical programs, operations, and performance management to improve clinical outcomes, member experience, and quality ratings.
Own quality performance outcomes across Stars, HEDIS, CAHPS, and all state and federal quality programs, ensuring results meet regulatory, contractual, and organizational expectations.
Ensure compliance with CMS, state Medicaid agencies, NCQA, and other regulatory and accreditation requirements, including audit preparation, execution, and remediation.
Oversee provider quality and delegated entity oversight, including audits, governance structures, corrective action plans, and ongoing performance monitoring.
Lead clinical data enablement and quality analytics in partnership with analytics teams, ensuring accurate, timely, and actionable reporting to identify trends, risks, and improvement opportunities.
Establish and maintain quality governance to proactively identify issues, manage risk, and drive sustained performance improvement.
Partner with clinical leaders, operational teams, and network providers to embed quality expectations into workflows, care delivery, documentation practices, and performance management.
Drive clinically informed interventions addressing gaps in care, chronic disease management, preventive services, and population health priorities.
Support value‑based care and population health initiatives through scalable quality frameworks and performance oversight.