Role SummaryAt Aetna, a CVS Health company, we are committed to helping members achieve their best health through affordable, high-quality, and integrated care.
The
Executive Director, Clinical Service Operations (Integrated Plans) is a senior enterprise leader accountable for the strategy, financial performance, regulatory compliance, and operational execution of Care Management programs supporting multi-state
Integrated Medicare-Medicaid plans, including Fully Integrated Dual Eligible (FIDE) and Highly Integrated Dual Eligible (HIDE) products.
This role oversees high-impact Care Management programs driving measurable improvements in total cost of care, quality outcomes, member experience, and regulatory performance, while ensuring alignment with CMS Model of Care (MOC) requirements and State Medicaid Agency Contracts (SMACs).
Key ResponsibilitiesStrategy & Integrated Care Leadership- Provide executive leadership for Integrated Care Management programs across multiple states and all FIDE/HIDE plans.
- Own Model of Care (MOC) design, implementation, and performance, ensuring integration into operational workflows.
- Ensure alignment with SMAC requirements and CMS expectations across Medicare and Medicaid benefits.
- Drive interdisciplinary care delivery across medical, behavioral health, LTSS, and social support domains.
Financial Management & P&L Accountability- Own full Care Management P&L, including PMPM cost management, staffing models, and ROI.
- Manage a large budget and large-scale workforce delivering integrated care services.
- Partner with Finance and Actuarial leaders to align operational performance with pricing, bids, and financial targets.
Regulatory Compliance & Audit Readiness- Ensure full compliance with CMS, Medicare, Medicaid, and state regulatory requirements.
- Lead audit readiness efforts, corrective action planning, and program integrity initiatives.
- Partner with State Medicaid teams and internal stakeholders to ensure successful audit execution and compliance outcomes.
Clinical Operations & Performance Management- Establish performance metrics, dashboards, and operating rhythms to track cost, quality, and member outcomes.
- Drive improvements in Stars, HEDIS, and broader quality performance measures.
- Lead vendor strategy, performance management, and enterprise integration efforts.
- Ensure alignment across clinical, quality, and operational functions to deliver integrated outcomes.
Leadership & Organizational Effectiveness- Lead and develop high-performing, multi-state clinical and operational teams.
- Drive workforce strategy, organizational design, and scalable staffing models aligned to integrated care delivery.
- Foster a culture of accountability, continuous improvement, innovation, and inclusion.
- Serve as a senior leader engaging internal and external stakeholders, including executive forums.
Required QualificationsThe candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company's business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:
- 15+ years of leadership experience in healthcare operations, including care management, medical management, and provider networks.
- Proven ability to lead complex, multi-state clinical operations with significant financial accountability.
- Strong business and financial acumen, including P&L oversight, PMPM models, and ROI delivery.
- Deep understanding of Medicare Advantage, Medicaid, and integrated (FIDE/HIDE) plan operations.
- Demonstrated success driving operational performance, quality outcomes, and cost improvement.
- Strong executive presence and ability to influence senior stakeholders.
- Experience leading large, matrixed teams and cross-functional initiatives.
Preferred Qualifications- 10+ years of progressive leadership experience in clinical operations, population health, or integrated care delivery.
- Active clinical license (e.g., RN, NP, LCSW, LICSW, or equivalent).
- Lean / Six Sigma expertise (Black Belt preferred) with demonstrated process improvement impact.
- Proven success improving total cost of care, quality outcomes, and member experience at scale.
- Experience with vendor strategy, partnerships, and performance management in integrated models.
- Deep knowledge of Stars, HEDIS, CMS regulations, and Medicaid integration requirements.
- Ability to operate effectively in a highly matrixed, enterprise environment.
Education Requirements- Required: Bachelor's degree or equivalent experience
- Preferred: Master's degree in healthcare administration, public health, business, or related field.
Pay RangeThe typical pay range for this role is:
$131,500.00 - $303,195.00
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.
Great benefits for great peopleWe 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: 07/03/2026
