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Position Summary
CVS Health, Aetna is seeking to hire an AVP, Chief Operating Officer for Medical Affairswith deep experience in enterpriselevel clinical operations. Reporting directly to Aetna's Senior Vice President & Chief Medical Officer, this senior executive will serve as the primary operational leader overseeing all core Aetna Medical Affairs functions, including utilization management, appeals, care management, care model design, clinical pathways, Network/Provider Engagement, and clinical enablement programs.
The AVP, COO for Medical Affairs will act as astrategic partnerto theCMOVPs for Commercial, Medicare, and Medicaid as well as to theVP of Utilization Management, ensuring alignment between lineofbusiness strategies and Medical Affairs operations. This leader will also serve as theprincipal operational interfacewithAetna Clinical Solutions (ACS)andNetworkleadership, ensuring crossfunctional integration, operational readiness, and consistent national execution.
The successful candidate will bring an enterprise mindset and the ability to build a unified operating model across Aetna Medical Affairs. This includes developing consistent national processes, ensuring compliance and performance, advancing technologyenabled operations, and driving scalable, measurable improvements in quality, efficiency, and member and provider experience.
Major Responsibilities
Enterprise Strategic Leadership
• Serves as a key strategic advisor to theAetna CMOVPs for Commercial, Medicare, and Medicaid, and to theVP for Utilization Management, ensuring Medical Affairs operations support and enabling each line of business's clinical and financial goals.
• Functions as theprimary operational liaisonwith ACS and Network leadership, driving crossAetna enterprise alignment of clinical operations, policy, staffing, and operating standards.
Enterprise Operating Framework & Governance
• Leads development of theenterprise Aetna Medical Affairs operating model, spanning utilization management, appeals, care management, care model design, clinical pathways, network alignment, and quality programs.
• Med Affairs lead forAetna enterprise-wide operating plans, integrating Medical Affairs with ACS, Network, Technology, Analytics, and businessunit clinical leadership.
• Ensures consistent national operating standards, documentation, workflows, and performance expectations across all Aetna Medical Affairs programs.
Performance Management, Dashboards & Metrics
• Designs and oversees dashboards, KPIs, and scorecardsfor all Aetna Medical Affairs functions and leverages those data points to optimize and drive performance.
• Establishes performance review structures, operational earlywarning systems, and transparent reporting mechanisms for Aetna Medical Affairs leadership and lineofbusiness partners.
• Partners closely with analytics and technology teams to leverage data, insights, and automation to improve outcomes and efficiency.
Financial & Resource Management
• Oversees operational budgets, including monitoring, forecasting, and costmanagement activities
• Ensures resources are deployed efficiently and investments support operational and performance goals
CrossFunctional Operations & Execution
• Leadsendtoend operational integrationacross Aetna Medical Affairs, ACS, Network, Technology, Analytics, and businessunit clinical teams.
• Oversees national operations including ~60 directteam FTE,300+ transactional clinicians, and other functions through a dottedline partnership model.
• Drivestechnologyenabled operational transformation, including modernization through automation, AIenhanced workflows, digital clinical tools, and datadriven operating models.
• Provides strategic thought leadership to the SAI process to identify key operational improvements and guide enterprisealigned solutions.
Required Qualifications
• 12+ years of progressive experience and responsibility at a senior leadership level in managed healthcare operations, compliance, or related field.
• Deep understanding of utilization management, and how it impacts healthcare quality and total cost of care.
• Deep understanding of clinical/claims systems and processes, and how they relate to member support services, payment integrity, and other connected processes.
• Deep understanding of compliance and quality programs (e.g., NCQA, HEDIS).
• Experience in addressing issues impacting member and provider experience.
• Demonstrated ability to work collaboratively across functions to align on shared goals, integrated processes, and KPIs.
• Demonstrated leadership with relevant initiatives: business process optimization, cross-functional integration, strategic operational planning, risk management.
• Proven ability to leverage understanding of the emerging healthcare environment to create the platform for change and to meet demands for evolving operational needs.
• Demonstrated ability to lead and influence cross-functionally, organize and integrate strategies, and align stakeholders on priorities and deadlines.
• Strong analytical and problem-solving skills, with a data-driven approach to decision-making.
• Ability to thrive in a fast-paced, dynamic environment and manage multiple priorities effectively.
• Travel - Based on needs of the business.
Preferred Qualifications
Location
Hartford, CT or Wellesley, MA (preferred)
Ability to work Hybrid Model (in office Tuesday / Wednesday / Thursday - preferred)
Education
Bachelors Degree is required
Advanced degree in healthcare administration or business administration is preferred
Pay Range
The typical pay range for this role is:
$157,800.00 - $363,936.00
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, visithttps://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.