Executive Director, Clinical Service Operations; Integrated Plans

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.

At Aetna, a CVS Health company, we are committed to helping members achieve their best health through affordable, high-quality, and integrated care.

The Executive Director, Clinical Service Operations (Integrated Plans) is a senior enterprise leader accountable for the strategy, financial performance, regulatory compliance, and operational execution of Care Management programs supporting multi-state Integrated Medicare-Medicaid plans, including Fully Integrated Dual Eligible (FIDE) and Highly Integrated Dual Eligible (HIDE) products.

This role oversees high-impact Care Management programs driving measurable improvements in total cost of care, quality outcomes, member experience, and regulatory performance, while ensuring alignment with CMS Model of Care (MOC) requirements and State Medicaid Agency Contracts (SMACs).

• Provide executive leadership for Integrated Care Management programs across multiple states and all FIDE/HIDE plans.
• Own Model of Care (MOC) design, implementation and performance, ensuring integration into operational workflows.
• Ensure alignment with SMAC requirements and CMS expectations across Medicare and Medicaid benefits.
• Drive interdisciplinary care delivery across medical, behavioral health, LTSS, and social support domains.

• Own full Care Management P&L, including PMPM cost management, staffing models, and ROI.
• Manage a large budget and a large‑scale workforce delivering integrated care services.
• Partner with Finance and Actuarial leaders to align operational performance with pricing, bids and financial targets.

• Ensure full compliance with CMS, Medicare, Medicaid and state regulatory requirements.
• Lead audit readiness efforts, corrective action planning and program integrity initiatives.
• Partner with State Medicaid teams and internal stakeholders to ensure successful audit execution and compliance outcomes.

• Establish performance metrics, dashboards and operating rhythms to track cost, quality and member outcomes.
• Drive improvements in Stars, HEDIS and broader quality performance measures.
• Lead vendor strategy, performance management and enterprise integration efforts.
• Ensure alignment across clinical, quality and operational functions to deliver integrated outcomes.

• Lead and develop high‑performing, multi‑state clinical and operational teams.
• Drive workforce strategy, organizational design and scalable staffing models aligned to integrated care delivery.
• Foster a culture of accountability, continuous improvement, innovation and inclusion.
• Serve as a senior leader engaging internal and external stakeholders, including executive forums.

The candidate will have a strong work ethic, be a self‑starter and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 15+ years of leadership experience in healthcare operations, including care management, medical management and provider networks.
• Proven ability to lead complex, multi‑state clinical operations with significant financial accountability.
• Strong business and financial acumen, including P&L oversight, PMPM models and ROI delivery.
• Deep understanding of Medicare Advantage, Medicaid and integrated (FIDE/HIDE) plan operations.
• Demonstrated success driving operational performance, quality outcomes and cost improvement.
• Strong executive…