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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 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.
Job Responsibility:
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
Requirements:
15+ years of progressive leadership experience in healthcare, with accountability for clinical strategy, policy, innovation, or medical cost management
Clinical degree (e.g., MD, DO, RN, PharmD) would be valued but not required
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
Value Based Care knowledge will be highly valued
Experience integrating analytics, innovation, and policy into scalable clinical operations
Proven experience leading and developing talent
Nice to have:
Clinical degree (e.g., MD, DO, RN, PharmD) would be valued but not required