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.

Position Summary

CVS Health, Aetna is seeking to hire an AVP, Chief Operating Officer for Medical Affairs with deep experience in enterprise‑level 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 a strategic partner to the CMO‑VPs for Commercial, Medicare, and Medicaid as well as to the VP of Utilization Management, ensuring alignment between line‑of‑business strategies and Medical Affairs operations. This leader will also serve as the principal operational interface with Aetna Clinical Solutions (ACS) and Network leadership, ensuring cross‑functional 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 technology‑enabled 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 the Aetna CMO‑VPs for Commercial, Medicare, and Medicaid, and to the VP for Utilization Management, ensuring Medical Affairs operations support and enabling each line of business's clinical and financial goals.
• Functions as the primary operational liaison with ACS and Network leadership, driving cross‑Aetna enterprise alignment of clinical operations, policy, staffing, and operating standards.

Enterprise Operating Framework & Governance

• Leads development of the enterprise Aetna Medical Affairs operating model, spanning utilization management, appeals, care management, care model design, clinical pathways, network alignment, and quality programs.
• Med Affairs lead for Aetna enterprise-wide operating plans, integrating Medical Affairs with ACS, Network, Technology, Analytics, and business‑unit 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 scorecards for all Aetna Medical Affairs functions and leverages those data points to optimize and drive performance.
• Establishes performance review structures, operational early‑warning systems, and transparent reporting mechanisms for Aetna Medical Affairs leadership and line‑of‑business 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 cost‑management activities
• Ensures resources are deployed efficiently and investments support operational and performance goals

Cross‑Functional Operations & Execution

• Leads end‑to‑end operational integration across Aetna Medical Affairs, ACS, Network, Technology, Analytics, and business‑unit clinical teams.
• Oversees national operations including ~60 direct‑team FTE, 300+ transactional clinicians, and other functions through a dotted‑line partnership model.
• Drives technology‑enabled operational transformation, including modernization through automation, AI‑enhanced workflows, digital clinical tools, and data‑driven operating models.
• Provides strategic thought leadership to the SAI process to identify key operational improvements and guide enterprise‑aligned 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, visit https://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.