Why CVS Health? – A Vision with Heart
CVS Health is more than a pharmacy giant; it is a transformational health‑care ecosystem that blends retail accessibility with cutting‑edge clinical services. Our purpose, “Bringing Our Heart to Every Moment of Your Health,” reflects a deep commitment to putting people—patients, members, and employees—at the center of everything we do. From innovative digital health platforms to community‑focused care programs, CVS Health leads the industry in making health‑care personal, convenient, and affordable. As part of the Aetna Better Health network, our Virginia‑based members receive comprehensive, coordinated care that addresses physical, mental, and social determinants of health.
About the Role: Remote Principal Clinical Leader – Aetna Better Health of Virginia
This position is a senior, strategic leadership role that operates on a remote basis, yet requires occasional travel across Virginia to engage with stakeholders, attend state‑wide meetings, and foster collaborative relationships. As the Principal Clinical Leader, you will shape the future of clinical operations for the Aetna Better Health segment, overseeing care coordination, risk screening, member engagement, and compliance with state and federal regulations. You will be a pivotal member of the Key Personnel team, driving both clinical excellence and financial stewardship.
Core Purpose
Develop, implement, and continuously improve clinical programs that deliver high‑quality, bio‑psychosocial care to our member population while achieving measurable improvements in health outcomes, member satisfaction, and cost efficiency.
Key Responsibilities
- Clinical Operations Leadership: Direct a multidisciplinary clinical team responsible for Health Risk Screenings, Comprehensive Assessments, Care Plan development, and enrollees’ interventions in line with Virginia state contracts.
- Strategic Planning & Execution: Create and execute a multi‑year strategic and operational business plan that aligns with organizational goals and regulatory requirements.
- Regulatory & Accreditation Liaison: Serve as the primary point of contact with state regulators, accrediting bodies, and internal compliance units, ensuring all programs meet or exceed standards.
- Financial Performance Management: Oversee budgeting, cost‑containment, and revenue cycle processes; develop initiatives that improve clinical outcomes while optimizing financial performance.
- Cross‑Functional Integration: Partner with claims, member services, utilization management, quality, compliance, and network/provider services to create seamless workflows and eliminate silos.
- Quality Improvement & Innovation: Lead quality improvement projects, leveraging data analytics to identify gaps, implement evidence‑based interventions, and monitor performance metrics.
- Stakeholder Engagement: Design and deliver presentations, webinars, and consultations for existing and prospective partners, illustrating program impact and value.
- Process Optimization: Evaluate, redesign, and document policies and procedures that enhance operational efficiency across multiple business functions.
- Performance Analytics: Synthesize program data to produce actionable insights, reporting on clinical outcomes, utilization trends, and member satisfaction.
- Leadership & Culture Building: Inspire, mentor, and develop the clinical team, fostering a culture of compassion, accountability, and continuous learning.
- Travel & Representation: Attend statewide meetings, conferences, and partner site visits (up to 15% travel), representing CVS Health with professionalism and insight.
Essential Qualifications
- Current, unencumbered Virginia RN license with hands‑on experience in care management.
- Nationally recognized case management certification (CCM, ACMA, or equivalent) or ability to obtain certification within 90 days of hire.
- Minimum five (5) years of clinical practice in physical or behavioral health settings.
- At least five (5) years of progressive management or clinical leadership experience, preferably within a Medicaid, managed‑care, or insurance environment.
- Proficiency with Microsoft Office Suite, electronic health record (EHR) platforms, and data reporting tools; minimum three (3) years of documented experience.
- Strong analytical ability to interpret clinical and operational data, and translate findings into strategic initiatives.
- Excellent written and verbal communication skills, with the capability to engage diverse internal and external audiences.
- Reliable transportation and willingness to travel statewide (up to 15% of the time) and intermittently for national engagements.
Preferred Qualifications
- Master’s degree in Nursing, Public Health, Health Administration, or a related field.
- Experience managing Medicaid populations, including familiarity with state Medicaid contracts, waiver programs, and value‑based payment models.
- Background in developing and scaling population‑health initiatives, risk adjustment, or accountable care organization (ACO) models.
- Knowledge of accreditation standards such as NCQA, URAC, or Joint Commission.
Core Competencies & Skills
- Strategic Vision: Ability to envision long‑term clinical pathways and align them with business objectives.
- Change Management: Proven track record of leading complex transformation projects in dynamic environments.
- Interpersonal Influence: Skilled at building relationships across functional lines and influencing senior leadership.
- Data‑Driven Decision Making: Comfortable using BI tools, dashboards, and statistical methods to guide program improvements.
- Regulatory Expertise: Deep understanding of state and federal health‑care regulations affecting care coordination and managed care.
- People Development: Commitment to coaching, mentoring, and championing professional growth within the team.
- Customer‑Centric Mindset: Passion for delivering compassionate, high‑quality care that meets member needs and expectations.
Career Growth & Learning Opportunities
CVS Health invests heavily in the professional development of its people. As a Principal Clinical Leader, you will have access to:
- Leadership Development Programs: Tailored executive coaching, mentorship circles, and cross‑functional rotation experiences.
- Continuing Education: Tuition reimbursement for advanced degrees, certifications, and specialized training in population health, health economics, and informatics.
- Innovation Labs: Participation in CVS Health’s digital health incubator, where you can pilot AI‑driven care models, tele‑health solutions, and predictive analytics tools.
- National Network: Opportunities to collaborate with clinical leaders across the United States, expanding your influence and professional network.
- Pathway to Executive Roles: Proven success in this senior role can position you for Vice‑President or Chief Clinical Officer pathways within CVS Health or its Aetna subsidiaries.
Work Environment & Culture
While this role is remote, CVS Health maintains a vibrant, inclusive culture that encourages collaboration, transparency, and work‑life balance. Employees enjoy:
- Flexible Work Arrangements: Remote‑first policy with occasional in‑person engagements.
- Diversity, Equity, & Inclusion (DEI): Active employee resource groups, DEI training, and a commitment to building a workplace where every voice is heard.
- Health‑Centered Benefits: Company‑wide wellness programs, mental‑health resources, and employee assistance services.
- Community Impact: Volunteer initiatives that allow you to give back to Virginia communities, reinforcing our mission to improve health outcomes at the grassroots level.
- Recognition & Rewards: Regular acknowledgment programs that celebrate clinical excellence, innovation, and teamwork.
Compensation, Perks, & Benefits
We offer a highly competitive total‑reward package that reflects the seniority and impact of this role. While exact figures are based on experience, education, and market considerations, the range typically falls between $110,467.50 and $237,900.00 annually, plus the following components:
- Performance‑Based Bonus & Incentives: Eligibility for annual bonuses, short‑term incentives, and possibly equity awards.
- Comprehensive Health Benefits: Medical, dental, and vision coverage with multiple plan options.
- Retirement Savings: 401(k) plan with company match and an Employee Stock Purchase Plan (ESPP).
- Life & Disability Insurance: Fully‑paid term life insurance, short‑ and long‑term disability coverage.
- Paid Time Off: Generous PTO accruals, paid holidays, and sick leave in accordance with state law.
- Well‑Being Programs: Access to fitness subsidies, mindfulness apps, and health‑coach services.
- Professional Development: Free enrollment in internal courses, external conferences, and leadership academies.
- Employee Discounts: Savings on CVS Pharmacy products, retail stores, and partner merchant discounts.
How to Apply
If you are a visionary clinical leader who thrives in a fast‑moving, data‑driven environment and is passionate about shaping the future of population‑health management, we want to hear from you. Submit your resume and a compelling cover letter that showcases your achievements, leadership philosophy, and why you are the ideal fit for this remote, high‑impact role.
Apply Now – Join the CVS Health Family
Closing Statement
At CVS Health, your expertise will not only advance your career—it will touch the lives of thousands of Virginians seeking coordinated, compassionate care. Embrace the opportunity to lead with heart, innovate with purpose, and make a lasting impact on the health of our communities. Apply today and become a catalyst for change.
Apply Now