Sr. Clinical Solutions MD, Commercial Clinical Strategy

Location: Nebraska

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.

Job Purpose and

Summary:

Join a mission-driven organization at a transformative moment in U.S. health care. As Senior Medical Director, Commercial Clinical Strategy at Aetna, a CVS Health company, you will serve as a key physician leader for Aetna's Commercial (employer group) business, responsible for defining and advancing our clinical strategy across our most critical conditions and member populations.

Reporting directly to the Vice President, Chief Medical Officer, Commercial & Innovation, and working in close partnership with senior leaders across Medical Affairs, Medical Economics, Analytics, Clinical Operations, Commercial Product, and Network, this role sits at the center of how Aetna translates clinical insight into measurable business and health outcomes for tens of millions of Commercial members.

The Senior Medical Director, Commercial Clinical Strategy will be responsible for pinpointing the failure points across the member journey that drive poor outcomes and excess costs, sizing the clinical and financial opportunity of closing those gaps, then developing, prioritizing, and sequencing interventions across all available levers into a multi-year roadmap.

We are seeking a bold, analytically rigorous physician executive who can operate at the intersection of clinical medicine, population health, and business strategy. The ideal candidate brings a proven track record of designing and scaling clinical strategies that elevate quality of care, affordability, and the member experience.

Primary Job

Duties & Responsibilities:

Build and maintain rigorous, evidence-based clinical strategies for each priority condition area (e.g. Musculoskeletal, Oncology, Maternity, Cardiometabolic disease) and priority populations (e.g. high-cost claimants, high-cost drug utilizers, and other longitudinally complex populations as identified through data analysis)
For each priority area, identify and map the key failure points across the member journey - clinical, behavioral, and structural - that drive poor outcomes and excess costs

Collaborate with Medical Economics and Analytics colleagues to build rigorous, bottoms-up opportunity models that quantify the clinical and financial value of closing identified gaps

Work across utilization management, care management, benefit design, product, pharmacy, and network to identify interventions and solutions to close identified gaps Prioritize interventions based on expected impact and implementation feasibility; develop clear decision criteria and recommendations for leadership investment and resource allocation

Translate prioritized strategies into sequenced, multi-year roadmaps with clear milestones, owners, dependencies, and success metrics

Collaborate with Medical Affairs and Clinical Operations colleagues driving cross-line-of-business clinical innovation "care model" activities to ensure alignment to Commercial clinical strategy and leverage shared resources and expertise to move forward Commercial initiatives

Represent the Commercial Medical Affairs team in product development, benefit design, and vendor selection processes as needed

Contribute to employer client engagement, RFP responses, and external-facing thought leadership as needed

Maintain active awareness of clinical innovation, health policy, competitor strategies, and market-shaping trends across priority clinical areas

Required Experience and Qualifications MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)
Active and current medical license (MD or DO) without encumbrances in at least one U.S. state

Board Certification including Maintenance of Certification in a specialty of the American Board of Medical Specialties (ABMS) or (AOA)
Minimum 5 years of work experience in managed care, health plan strategy, or equivalent (commercial experience preferred)
Proven track record developing and driving clinical strategies that deliver measurable cost and quality outcomes

Strong analytical skills with demonstrated ability to build and interpret complex health care cost, quality, and utilization analyses

Exceptional stakeholder management and executive communication skills; demonstrated ability to build coalitions and drive alignment across diverse audiences

Ability to work virtually with occasional travel for in-person meetings (up to 15%)Preferred

Experience and Qualifications:

Advanced degree (MBA, MPH, MPP, MHA, or equivalent) preferred
10+ years of combined clinical and health plan, consulting, or health care strategy experience

Strong financial acumen and experience building business cases and…