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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Purpose and Summary:

This is a remote position and may sit anywhere within the U.S.

The Lead Director, Solutions and Operations Excellence role within Medical Affairs works with clinical leaders and business teams across the enterprise to drive innovation and operational excellence related to population health and care model strategies. They will act independently to drive scoping, design, and implementation of cutting-edge solutions, including programs which optimize Case Management and Utilization Management operations, enhance efficiency and improve member outcomes. This role will serve as a key leader in transforming our core Case Management review and other clinical processes and possess a deep understanding of health plan operations, regulatory requirements and intricacies of CM and UM workflow optimization. They will be responsible for leading the clinical team in identifying opportunities for process improvement, leveraging technology and best practices, leading cross functional teams to build and implement scalable solutions, and demonstrating clinical impact and business value. This role requires exceptional problem-solving abilities, focus on both business needs and operational efficiency, and the capacity to drive cross-functional collaboration, executive alignment, and organizational change.

Primary Job Duties & Responsibilities:

The Lead Director works across the Aetna and CVS enterprise in a highly collaborative partnership with multiple business units to drive better

clinical outcomes and cost-savings initiatives. The Lead Director is responsible for leveraging their expertise in population health care models to lead workstreams aimed at identifying opportunities, driving execution and monitoring performance to achieve desired health outcomes.

Responsibilities:

+ Collaborate closely with clinical and operational leaders to understand business needs, challenges, and strategic objectives.

+ Orchestrate in-depth analyses of current state operational processes, identifying pain points, inefficiencies and opportunities for improvement.

+ Lead workgroups through the ideation and operationalization of new solutions, defining scope, requirements and desired outcomes with timelines and roadmaps.

+ Ensure solutions are scalable, sustainable, compliant and seamlessly integrated with existing processes and systems.

+ Lead cross functional implementation teams, ensuring successful execution and adoption of new initiatives.

+ Define key performance indicators (KPIs) and metrics in concert with business partners to measure the effectiveness and impact of implemented solution on cost savings and quality outcomes.

+ Identify and mitigate potential risks and challenges to solve management and business problems.

+ Navigate a highly matrixed, collaborative work environment to meet goals.

+ Develop positive interpersonal relationships with stakeholders across the enterprise to facilitate effective collaboration.

+ Present solutions proposals, progress updates, and performance results to senior leadership.

Required Qualifications:

+ 10+ years in health care strategy, care delivery operations, population health, or related leadership roles

+ Deep understanding of value-based care, health equity, and integrated delivery systems

+ Proven success leading complex business-wide initiatives with measurable business and clinical impact

+ Exceptional communication, facilitation, and stakeholder management skills

Preferred Qualifications:

Masters in related field (MBA, MPP, MPH, MPA, MHA, MSHP, etc.) preferred but not required.

Education

Bachelor required/Master preferred

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .

+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 11/03/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.