Executive Medical Director, Medical Affairs

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Oversee the governance of Aetna’s centralized MD Quality function, ensuring it aligns with enterprise standards and regulatory requirements.

• Lead a diverse team comprising Clinical and Admin Auditors, Trainers, Data Analysts, and a Program Ops Manager.

• Analyze trends in decisions and variability to pinpoint high-impact areas for targeted enhancements.

• Assess audit methodologies and insights to guarantee that findings are actionable, defensible, and aligned with strategic priorities.

• Facilitate MD Quality forums to establish standards and promote transparency and alignment across lines of business.

• Focus on prioritizing quality improvement and remediation efforts, emphasizing the most impactful interventions.

• Oversee the monitoring of quality metrics and outcomes to ensure accountability and sustained improvements at both individual and team levels.

• Represent MD Quality in executive forums, offering updates on performance trends, risks, and strategies for mitigation.

• Act as a trusted clinical advisor, fostering a culture of quality, rigor, and accountability.

• Maintain a cross-functional partnership with ACS to drive comprehensive alignment and quality enhancements.

• Shape the future operational model of MD Quality.

• Enhance review methodologies, performance calibration, and governance for clinically sound MD decisions that adhere to enterprise standards and prioritize member needs.

⛳️ Requirements

• Over 10 years of clinical experience with advancing leadership roles in utilization management, medical policy, clinical operations, or quality oversight.

• Experience in leading clinical quality reviews or MD performance calibration.

• Profound understanding of clinical coverage determinations, appeals, regulatory standards (such as CMS, NCQA), and medical necessity criteria.

• Proven experience in developing structured training programs to enhance performance.

• Demonstrated capability to influence senior clinical and business leaders within a complex, matrixed organization.

• Strong analytical skills, including the ability to interpret variability metrics, IRR results, and audit findings.

• Possess executive presence and communication skills, with experience presenting to senior leadership.

• Board certification as an MD or DO is required.

• Training in healthcare quality, public health, health policy, or healthcare administration.

• Experience in designing or transforming internal clinical quality or audit programs.

• Direct experience with IRR methodology and performance calibration frameworks.

• Familiarity with various lines of business (Commercial, Medicare, Medicaid).

• Background in change management or leading enterprise-wide quality improvement initiatives.

🏝️ 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.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.