Lead Director - Clinical Innovation

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 healthcare one person, one family and one community at a time.

The Lead Director, UM Innovation & Strategic Analysis is a critical leadership role responsible for defining and driving the strategic analysis portfolio, enterprise transformation priorities, and Utilization Management (UM) automation strategy within Aetna’s Clinical Solutions business unit. This role serves as a trusted advisor to senior leadership by identifying opportunities to improve clinical, operational, and financial performance through data-driven insights, market intelligence, business case development, and technology-enabled innovation.

This leader is responsible for evaluating emerging trends, competitive dynamics, and operational performance to identify opportunities that create enterprise value and strengthen Aetna's competitive position. Working across clinical, operational, product, and technology organizations, the role drives analysis, portfolio prioritization, and business transformation initiatives with a focus on modernizing Utilization Management through automation, artificial intelligence, and digital innovation. The position is accountable for delivering measurable business outcomes through effective governance, value realization, and execution of high-impact strategic initiatives.

• Evaluate Utilization Management performance, market trends, regulatory developments, and emerging technologies to identify opportunities that improve clinical outcomes, drive operational efficiency, reduce administrative burden, and create sustainable business value.
• Lead the development of strategic analyses, business cases, and investment recommendations that shape UM strategy, prioritize transformation initiatives, and influence executive decision-making through data-driven insights and structured problem-solving.
• Drive strategic portfolio planning for UM modernization initiatives, including opportunity assessment, prioritization, resource alignment, funding recommendations, and value realization tracking.
• Partner with Clinical Operations, Product, Technology, and Enterprise Innovation teams to define and execute a multi-year Utilization Management modernization roadmap aligned to business priorities and customer needs.
• Lead the identification, evaluation, and implementation of automation opportunities across UM leveraging AI, Generative AI, predictive analytics, NLP, business rules engines, and decision support technologies.
• Develop and monitor KPIs, dashboards, and performance measurement frameworks to quantify the impact of automation and transformation initiatives on productivity, service levels, quality outcomes, provider and member experience, and operating costs.
• Provide strategic oversight and governance for innovation pilots, proof-of-value assessments, and transformation initiatives to ensure scalability, business alignment, and achievement of targeted outcomes.
• Build influential relationships across the organization and serve as a trusted advisor to senior leaders on UM strategy, operational performance, automation opportunities, and enterprise transformation priorities.
• Manage and develop a high-performing team through coaching, mentoring, and professional development while fostering a culture of innovation, accountability, and continuous improvement.

• 10+ years of experience leading strategic planning, business analysis, consulting, portfolio management, transformation, or innovation initiatives within healthcare, health insurance, or managed care organizations.
• Deep understanding of health plan operations including Utilization Management, Policy Management, Care Management, Quality, Compliance, Regulatory Management, Claims, and Provider Networks.
• Demonstrated experience developing and leading enterprise strategic initiatives from concept through implementation and value realization.
• Strong analytical and problem-solving skills, including business modeling, financial analysis, data synthesis, and development of executive-level recommendations.
• Proven success in enterprise portfolio management, strategic planning, and prioritization of complex initiatives.
• Experience with data visualization tools and advanced analytics technologies, including SQL, Python, and cloud-based data platforms.
• Strong understanding of automation, AI-enabled workflows, digital transformation, and technology-driven operational improvement.
• Expertise in developing business cases, defining success metrics, and measuring return on investment for strategic initiatives.
• Strong interpersonal and communication skills with the ability to…