Principal Clinical Leader – RN

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

📋 Description

• Lead and manage Care Management and Utilization Management operations for the Commercial line of business.

• Provide both strategic and operational leadership for various dedicated plan sponsor populations.

• Enhance performance across clinical and operational leaders through goal setting, performance management, coaching, workforce planning, and continuous improvement.

• Act as the primary operational leader for assigned Commercial plan sponsors, fostering 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 teams on client-specific strategies.

• Oversee the delivery of Utilization Management while ensuring compliance with regulatory, accreditation, contractual, and quality standards.

• Direct the strategy and execution of Care Management, including clinical interventions, member engagement, care planning, and outcomes measurement.

• Monitor and enhance KPIs such as engagement, quality, utilization, financial performance, productivity, customer experience, and service levels.

• Utilize data analytics to pinpoint opportunities, implement corrective actions, and drive operational excellence.

• Lead organizational change, workforce transformation, and the 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 the state of residence.

• 10 years of relevant work experience.

• Minimum of 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 utilizing clinical and operational data to identify trends, develop actionable insights, and enhance quality, member experience, utilization, and cost outcomes.

• Proven track record in 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 is preferred.

• Experience supporting national employer groups, Fortune 500 clients, or large-scale Commercial populations is highly desirable.

• Master’s degree or equivalent clinical experience; BSN or MSN preferred.

• An Associate’s degree requires an additional 4 years of experience under CVS policy; a 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.