Lead Director – Clinical Innovation

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

📋 Description

• Assess the performance of Utilization Management, analyze market trends, regulatory changes, and emerging technologies to uncover opportunities for enhanced outcomes, efficiency, reduced administrative workload, and increased business value.

• Spearhead strategic analyses, develop business cases, and formulate investment recommendations to guide UM strategy and transformation priorities.

• Oversee strategic portfolio planning, evaluate opportunities, prioritize initiatives, align resources, recommend funding, and track value realization.

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

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

• Create and monitor KPIs, dashboards, and performance measurement frameworks for automation and transformation projects.

• Provide governance and strategic oversight for innovation pilots, proof-of-value assessments, and transformation initiatives.

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

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

• Promote a culture of innovation, accountability, and continuous improvement.

⛳️ Requirements

• A minimum of 10 years of experience leading strategic planning, business analysis, consulting, portfolio management, transformation, or innovation initiatives in healthcare, health insurance, or managed care organizations.

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

• Proven experience in leading enterprise strategic initiatives from inception through execution and value realization.

• Strong analytical and problem-solving capabilities, including business modeling, financial analysis, data synthesis, and providing executive-level recommendations.

• Experience in enterprise portfolio management, strategic planning, and prioritizing complex initiatives.

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

• Comprehensive understanding of automation, AI-driven workflows, digital transformation, and technology-based operational enhancements.

• Expertise in developing business cases, defining success metrics, and assessing return on investment.

• Excellent interpersonal and communication skills, capable of influencing senior leaders and key stakeholders.

• Bachelor’s Degree or equivalent professional experience.

• Over 5 years of leadership experience in innovation, advanced analytics, business process optimization, enterprise consulting, strategic planning, financial analysis, risk management, or related fields preferred.

• Experience in creating capabilities, products, services, operating models, or automation solutions that yield measurable business value preferred.

• Familiarity 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.

• Proficient in executive-level relationship management and influencing without direct authority preferred.

• Experience managing enterprise-wide portfolios and complex cross-functional initiatives preferred.

• Health domain certifications such as AHIP certifications are preferred.

🏝️ Benefits

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

• Target award 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.

• Comprehensive benefits package for eligible full-time colleagues and their families.