Lead Director – Payment Integrity Operational Execution and Strategy

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.

Overview:

Leads and oversees the business strategy team by setting strategic objectives and driving the organization's overall business strategy. Collaborates with senior leadership to develop long-term plans and align business strategies with the company's vision and mission. Conducts performance evaluations, mentor team members, and provides guidance on strategic analysis and planning. Evaluates new business opportunities, fosters innovation, and adapts strategies to meet evolving market conditions and industry trends.

Description of activities:

• Drive successful execution of strategic initiatives and programs within the organization.
• Collaborate with business and Cross Matrixed partners to enhance the Payment Integrity strategy and roadmap; translate and simplify ambiguous problems into frameworks which inform solutions to drive short and long-term business strategies
• Advises general managers on strategic alignment tools, program management methodologies for risk management and change control processes to ensure cohesiveness in departmental operations and processes.
• Identifies and capitalizes on potential business opportunities, partnerships, and collaborations that align with the organization's strategic objectives.
• Creates executive-ready reporting / measurement of program outcomes, business impacts, and lessons learned through documentation to inform future program planning efforts.
• Explores opportunities for interoperability, process optimization, and the adoption of new technologies to enhance operational efficiency and patient outcomes.
• Contributes to planning budgets for strategic initiatives and programs that drive organizational growth, operational effectiveness, and innovation.
• Contributes to top-level decision-making surrounding program execution and progress to ensure that program objectives are achieved within the defined timeframes and budgets.
• Leads and facilitates change initiatives that arise from strategic programs and communicates changes to stakeholders while managing resistance and ensuring smooth transitions.
• Develop and maintain relationships with wide range of stakeholders including business partners, HealthPlan leaders, other data and analytic teams, Legal, etc.

Required Qualifications

• 10-15 years work experience
• 10+ years problem mastery level Problem Solving  and decision making skills.
• Proven track record of execution and delivery (planning, delivering, and supporting)
• Strategy experience. 4+ years' experience strategy consulting or on strategy teams in large companies (complex problem solving and stakeholder management)
• Strong written and oral communication skills including delivering structured presentations to executive leadership
• Advanced Microsoft Powerpoint and Excel experience
• Comfort in ambiguity and ability to simplify complex problems

Preferred Qualifications

• Solid understanding and hands-on experience working with  Payment Integrity Operations
• Business Case development, Capital planning and demonstrated value realization/calculation post deployment/action outcome.

Education

Bachelor's degree in Business Analytics, Economics, Finance, Statistics, a quantitative field, or equivalent practical experience required

**We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy.  Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
Aetna Service Operations office/hub locations will be discussed with the selected candidate.

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.