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Vp, Clinical Insights, Innovation, & Policy - Aetna

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Hartford

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Contract Type:
Not provided

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Salary:

Not provided

Job Description:

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
  • Value Based Care knowledge will be highly valued
What we offer:
  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs

Additional Information:

Job Posted:
May 15, 2026

Expiration:
May 29, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:
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