Lead Decision Scientist

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The UM Analytics team provides data-driven insights that directly influence clinical and operational decision-making across Aetna’s Utilization Management organization. We partner with Medical Affairs leadership, Medical Directors, and operational teams to evaluate care models, identify cost and quality improvement opportunities, and translate complex healthcare data into actionable recommendations.

This Lead Decision Scientist will be embedded within the Medical Affairs analytics pod, serving as the primary analytics partner for care model leadership and clinical stakeholders. You will own the end-to-end analytics lifecycle — from intake and problem framing through data extraction, analysis, insight generation, and stakeholder presentation — for a portfolio of Medical Affairs projects. This is not a "run-the-report" role: you will be expected to proactively identify opportunities, shape the analytical agenda, and drive projects to completion, ensuring that insights translate into measurable business and clinical outcomes.

You will work closely with Medical Directors, care model leads, and cross‑functional operational teams to prioritize, scope, and deliver high‑impact analyses spanning areas such as care model performance evaluation, clinical program effectiveness, utilization trend analysis, and exploratory research to support new initiatives.

• 7+ years of professional experience in data analytics, decision science, or a quantitative analytics role
• 3+ years of experience working with healthcare data (claims, clinical, enrollment, or similar)
• Advanced proficiency in SQL, including complex query design across large-scale datasets (e.g., Big Query, Teradata, or similar enterprise data platforms)
• Demonstrated experience leading analytics projects end-to-end — from stakeholder problem definition through final deliverable and recommendation
• Experience building dashboards, reports, or data visualizations using tools such as Tableau, Power BI, Looker, or similar
• Track record of presenting analytical findings and recommendations to senior leadership or cross-functional business partners
• Proficiency in at least one programming language for data analysis (Python or R)
• Experience working in a matrixed environment with multiple concurrent stakeholder groups

• Strong understanding of managed care, utilization management, or health plan operations (e.g., familiarity with concepts such as DRG, clinical claim review, care model design, or medical policy)
• Ability to translate ambiguous business questions into structured analytical frameworks without heavy direction
• Proven ability to push projects forward independently — proactively managing timelines, escalating blockers, and driving stakeholders toward decisions
• Excellent communication and storytelling skills — can distill complex analytical findings into clear, concise narratives for both technical and non-technical audiences, including Medical Directors and operational leaders
• Strong consultative mindset — comfortable pushing back on requests to reframe problems, prioritize effectively, and ensure the right questions are being asked
• Experience mentoring or guiding junior analysts on analytical methodology and professional development
• Familiarity with statistical modeling, A/B testing, or causal inference methods applied to healthcare program evaluation
• Comfort working with ambiguity and evolving priorities in a fast-paced environment

Bachelor’s degree or equivalent work experience in Mathematics, Statistics, Computer Science, Analytics, Engineering, Public Health, Health Informatics, or related quantitative discipline. Master’s degree preferred.

The typical…