Lead Director – Clinical Innovation

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🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👨‍⚕️ Medical Director

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Evaluate Utilization Management performance, market trends, regulatory developments, and emerging technologies to identify opportunities for improved outcomes, efficiency, reduced administrative burden, and business value • Lead strategic analyses, business cases, and investment recommendations to shape UM strategy and transformation priorities • Drive strategic portfolio planning, opportunity assessment, prioritization, resource alignment, funding recommendations, and value realization tracking • Partner with Clinical Operations, Product, Technology, and Enterprise Innovation teams on a multi-year UM modernization roadmap • Identify, evaluate, and implement automation opportunities using AI, Generative AI, predictive analytics, NLP, business rules engines, and decision support technologies • Develop and monitor KPIs, dashboards, and performance measurement frameworks for automation and transformation initiatives • Provide governance and strategic oversight for innovation pilots, proof-of-value assessments, and transformation initiatives • Advise senior leaders on UM strategy, operational performance, automation opportunities, and enterprise transformation priorities • Manage and develop a high-performing team through coaching, mentoring, and professional development • Foster a culture of innovation, accountability, and continuous improvement

🎯 Requirements

• 10+ years of experience leading strategic planning, business analysis, consulting, portfolio management, transformation, or innovation initiatives within healthcare, health insurance, or managed care organizations • Deep understanding of health plan operations, including Utilization Management, Policy Management, Care Management, Quality, Compliance, Regulatory Management, Claims, and Provider Networks • Experience leading enterprise strategic initiatives from concept through implementation and value realization • Strong analytical and problem-solving skills, including business modeling, financial analysis, data synthesis, and executive-level recommendations • Experience in enterprise portfolio management, strategic planning, and prioritization of complex initiatives • Experience with data visualization tools and advanced analytics technologies, including SQL, Python, and cloud-based data platforms • Strong understanding of automation, AI-enabled workflows, digital transformation, and technology-driven operational improvement • Expertise in developing business cases, defining success metrics, and measuring return on investment • Strong interpersonal and communication skills with the ability to influence senior leaders and key stakeholders • Bachelor’s Degree or equivalent work experience • 5+ years of leadership experience in innovation, advanced analytics, business process optimization, enterprise consulting, strategic planning, financial analysis, risk management, or related disciplines preferred • Experience creating capabilities, products, services, operating models, or automation solutions that deliver measurable business value preferred • Experience with Utilization Management modernization and intelligent workflow automation preferred • Knowledge of Generative AI, machine learning, natural language processing, decision engines, APIs, workflow orchestration platforms, and predictive analytics preferred • Executive-level relationship management and ability to influence without direct authority preferred • Experience managing enterprise-wide portfolios and complex cross-functional initiatives preferred • Health domain certifications such as AHIP certifications preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Comprehensive benefits package for eligible full-time colleagues and their families