Principal Clinical Leader – RN

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🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $121.5k - $261.7k / year

⏰ Full Time

🟠 Senior

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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

• Lead and oversee Care Management and Utilization Management operations for the Commercial line of business • Provide strategic and operational leadership for multiple dedicated plan sponsor populations • Drive performance across clinical and operational leaders through goal setting, performance management, coaching, workforce planning, and continuous improvement • Serve as the primary operational leader for assigned Commercial plan sponsors and build stakeholder relationships • Represent the organization in client meetings, sponsor reviews, finalist presentations, performance discussions, and strategic planning sessions • Collaborate with Account Management, Sales, Product, Clinical, and Operations partners on client-specific strategies • Oversee Utilization Management delivery and compliance with regulatory, accreditation, contractual, and quality standards • Direct Care Management strategy and execution, including clinical interventions, member engagement, care planning, and outcomes measurement • Monitor and improve KPIs including engagement, quality, utilization, financial performance, productivity, customer experience, and service levels • Use data analytics to identify opportunities, implement corrective actions, and drive operational excellence • Lead organizational change, workforce transformation, and implementation of programs, technologies, workflows, and clinical capabilities • Partner with plan sponsors and senior leadership to align operations with business objectives and client expectations

🎯 Requirements

• Active, unrestricted RN license in state of residence • 10 years of relevant work experience • Minimum 8 years of progressive clinical leadership experience, including managing teams and other leaders • Leadership experience in Case Management and/or Utilization Management, primarily within Commercial Lines of Business • Strong understanding of Commercial healthcare benefits, employer-sponsored health plans, utilization management processes, population health strategies, and value-based care principles • Experience using clinical and operational data to identify trends, develop actionable insights, and improve quality, member experience, utilization, and cost outcomes • Experience driving performance across complex operations using analytics, performance management frameworks, continuous improvement methodologies, and workforce optimization strategies • At least 3 years of recent experience as an Aetna manager preferred • Experience supporting national employer groups, Fortune 500 clients, or large-scale Commercial populations highly desirable • Master’s degree or equivalent clinical experience; BSN or MSN preferred • Associate’s degree requires an additional 4 years of experience under CVS policy; bachelor’s degree requires an additional 2 years of experience • Up to 25% travel, including client meetings, leadership meetings, market visits, conferences, team events, and other business activities • Occasional weekends and holidays may be required • Ability to work varied hours based on team needs

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • 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