Lead Director – Clinical Innovation, Analytics Delivery

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

📋 Description

• Assess the performance of Utilization Management, including market trends, regulatory changes, and emerging technologies.

• Lead strategic evaluations, develop business cases, and make investment recommendations.

• Facilitate strategic portfolio planning for UM modernization projects, encompassing opportunity evaluation, prioritization, resource alignment, funding advice, and tracking of value realization.

• Collaborate with Clinical Operations, Product, Technology, and Enterprise Innovation teams to implement a multi-year roadmap for UM modernization.

• Identify, assess, and implement automation opportunities utilizing AI, Generative AI, predictive analytics, NLP, business rules engines, and decision support technologies.

• Create and oversee KPIs, dashboards, and frameworks for performance measurement.

• Provide strategic oversight and governance for innovation pilot programs, proof-of-value evaluations, and transformation efforts.

• Counsel senior leadership on UM strategy, operational performance, automation possibilities, and enterprise transformation priorities.

• Lead and nurture a high-performing team through coaching, mentoring, and professional development.

⛳️ Requirements

• Over 10 years of experience in strategic planning, business analysis, consulting, portfolio management, transformation, or innovation initiatives within healthcare, health insurance, or managed care sectors.

• Comprehensive knowledge of health plan operations, including Utilization Management, Policy Management, Care Management, Quality, Compliance, Regulatory Management, Claims, and Provider Networks.

• Proven track record in developing and executing enterprise strategic initiatives from concept through to implementation and value realization.

• Strong analytical and problem-solving capabilities, encompassing business modeling, financial analysis, data synthesis, and the formulation of executive-level recommendations.

• Established success in enterprise portfolio management, strategic planning, and prioritization of complex projects.

• Familiarity with data visualization tools and advanced analytics technologies, including SQL, Python, and cloud-based data platforms.

• In-depth understanding of automation, AI-driven workflows, digital transformation, and technology-led operational enhancements.

• Proficiency in crafting business cases, defining success metrics, and assessing return on investment for strategic projects.

• Excellent interpersonal and communication skills with the capability to effectively influence senior leaders and key stakeholders.

• Bachelor's Degree or equivalent work experience is required.

• AHIP certifications are preferred.

🏝️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base salary.

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that support physical, emotional, and financial well-being.