Ld DirProvider Transformation

Job DescriptionThe Lead Director, Provider Transformation reports directly to the Senior Medical Director of Aetna's Commercial Care Management Operations.The position leads a team of Business Strategists and Clinical Consultants who are responsible for achieving business goals and delivering superior solutions with Aetna's ACO and Joint Venture partners focused on medical cost management and quality. The role works in collaboration with Joint Venture leadership teams including CEO, COO, and Chief Medical Officers. The role works with both the Commercial and Medicare organizations within Aetna. The Lead Director provides strategic leadership for the development of provider centric assessments and performance improvement strategies, road map, tools, and methodologies. The Lead Director develops and implements performance improvement capabilities designed to enable Strategic, Business and Clinical Transformation within Aetna Clinical Services providers to help achieve the quadruple aim: improved clinical experience, better outcomes, lower costs, and improved patient experience.The Lead Director provides leadership in the development and implementation of transformation plans to achieve targeted improvement goals, implements solutions with provider organizations, and provides work stream oversight for professional level engagement delivery staff from across multiple teams.The Lead Director collaborates with other leaders to identify enabling technology and service products, programs and approaches that integrate informatics and performance improvement with clinical, business, strategic, and technology transformation. Travel: Maximum of 30% travel expected when COVID travel restrictions are lifted.Key Responsibilities Include:-Develops and prepares Senior Leadership presentations for ACO performance -Accountable for managing the providers' financial risk of ~ $250M for each region -Interacts, presents, and engages with C-suite level provider partners throughout the transformation journey-Designs, develops, and oversees implementation of a comprehensive customized strategy (ACO 2.0 roadmap) to drive a successful population health management operation for each of the region ACOs and Joint Venture provider partners-Captures and elevates to Senior Leadership the feedback from the marketplace and the provider community that will shape the Aetna Clinical Services strategies going forward-Supports provider partners through the implementation of the recommendations-Provides consultation and advisory support to the provider to close the gaps in the capabilities-Monitors and tracks ACO performance against the defined targets and engages with ACOs in deep dive projects for process improvement and review of technology enablement-Leads a team of business consultants and clinical consultants-Partners with clinical team in implementing and deploying various skills and transformation projects-Manages projects, people, customer expectations and business priorities to achieve constituent satisfaction-Oversees day-to-day activities of the team-Manages and builds a strong team through formal training, diverse assignments, coaching, mentoring and other development techniques-Motivates and is willing to understand and probe into technical details, and mentor others to do the same-Contributes to a motivated work environment by working effectively to achieve common goals-Drives the overall design or methodology of tactical and strategic advisory solutions that satisfy needs across products, segments, and clients to increase engagement-Strategic member of the Transformation Leadership team-Communicates and consults with Senior Leadership to ensure that informatics and performance improvement strategies focus on long term results and represent all constituencies effectively-Manages budgets, plans, and expenses for large scale strategic projects, and participates in cost center management-Collaborates with external provider partners and internal stakeholders to design, implement, and continually improve outcomes tracking and measurement models related to Provider Transformation-Collaborates with business partners to provide advice on metrics, tools, and outcomes models for development and evaluation of projects and programs-Proactively builds and maintains internal and external key relationships-Support Market Chief Medicare Officer with medical cost analysis and projections in collaboration with Medicare Actuary for bid processPay RangeThe typical pay range for this role is:Minimum: 100,000Maximum: 221,000Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications-Minimum 12 years managerial and project management experience requiredCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications-10+ years strong background in health care analysis methods and tools, health economics, ACO finance in payor and/or provider settings -5+ years in both payer and provider settings highly preferred including Commercial and Medicare Advantage experience -MBA-Ability to collaborate with and understand the needs of C-level executives and help translate those needs to an actionable plan. Demonstrated ability to communicate technical concepts and implications to business and policy decision-makers and clients-Outstanding verbal and written communication skills, including formal presentations for all levels of management combined with strong collaboration/influencing abilities-Deep knowledge of health care industry, policy, research design, predictive modeling, ACO finance methods and tools-Strategic business acumen and proven organizational, management, and leadership skill-Demonstrated collaborative style, with ability to influence diverse teams and build strong relationships-Demonstrated strategic thinking, problem solving and critical thinking abilities-Demonstrated success leading direct, indirect, and virtual teams in a matrixed environment successful direct report leadership and coaching experience-Demonstrated ability to negotiate complex and often contentious issues; reach consensus and work through people to achieve key goal-Financial acumen and experience with accountable care financial models including experience in Medicare bid process -Experienced working with clinical and claims data-Demonstrated success working with clinicians, finance, and operational leaders to drive performance improvement experience-Experience with delegation of clinical servicesEducation-Bachelor's degree or equivalent work experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15