Executive Director, Medical and Policy - Aetna

Executive Director, Medical and Payment Policy - Aetna page is loaded## Executive Director, Medical and Payment Policy - Aetnaremote type:
Remote/Hybrid locations:
CT - Hartford time type:
Full time posted on:
Posted Todaytime left to apply:
End Date:
March 27, 2026 (20 days left to apply) job requisition :
R0845986

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health(R), 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.
** Position Summary
** The Executive Director, Medical and Payment Policy, serves as a visionary leader at the intersection of clinical strategy and healthcare reimbursement. This executive-level role is responsible for shaping, developing, and implementing comprehensive medical and payment policies that drive organizational objectives, regulatory compliance, and financial sustainability. The Executive Director partners with clinical, operational, legal, and financial teams to ensure that policies are evidence-based, patient-centered, and aligned with industry standards, payer requirements, and evolving healthcare legislation.
** Responsibilities:
**** Policy Development and Implementation
*** Oversee the research, drafting, evaluation, and maintenance of medical, clinical, and payment policies to ensure compliance with federal, state, and local regulations.
* Facilitate stakeholder engagement and incorporate feedback from internal and external partners, including clinicians, payers, patients, and advocacy groups.
* Monitor emerging trends in medical practice, reimbursement, and healthcare legislation to proactively update policy frameworks.
* Ensure policies are driven by evidence-based practices and enhance the value and quality of patient care.
** Regulatory Affairs and Compliance
*** Stay abreast of regulatory requirements, legislative developments, and accrediting body standards to ensure all policies are fully compliant.
* Serve as the primary liaison with regulatory agencies on matters related to medical necessity, coding, coverage determinations, and payment methodologies.
* Lead internal audits and policy reviews to identify and mitigate compliance risks.
** Payment Policy and Reimbursement Strategy
*** Design and implement innovative payment models that promote efficiency, quality outcomes, and cost-effective care delivery.
* Collaborate with actuaries and financial teams to analyze the impact of payment policy changes on organizational finances and provider networks.
* Educate internal stakeholders on payment methodologies, including fee-for-service, value-based care, bundled payment, and alternative payment models.
** Stakeholder Engagement and Relationship Management
*** Build and maintain collaborative relationships with physicians, hospitals, health systems, payer organizations, government agencies, and patient advocacy groups.
* Represent the organization at industry conferences, regulatory hearings, and professional associations.
* Lead initiatives to gather and synthesize stakeholder input on policy development and policy change management.
** Team Leadership and Talent Development
*** Recruit, mentor, and develop a high-performing team of policy professionals and analysts.
* Foster a culture of excellence, accountability, and continuous improvement.
* Oversee performance management, professional development, and succession planning within the department.
** Required Qualifications
*** 15+ years of progressive leadership experience in healthcare policy, medical management, reimbursement, or healthcare administration.
* Deep knowledge of medical policy development, payment models, and the U.S. health care regulatory environment (including CMS, Medicaid, ACA, etc.).
* Demonstrated experience with the implementation and management of value-based care, alternative payment models, and clinical guidelines.
* Strong analytic, problem-solving, and decision-making…