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.

Key Responsibilities

• 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.

Location: Remote or Hybrid

Qualifications

• 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

Pay Range

The typical pay range for this role is:

$0.00 - $0.00

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 05/29/2026

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