CVS Health · New Haven
Other
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.
Position Overview
Quality is part of Aetna’s DNA. We are committed to ensuring that every MD decision reflects sound clinical judgment, consistent application of evidence-based criteria, and an unwavering focus on doing what is best for our members. To strengthen and scale this commitment, Aetna Medical Affairs is establishing a centralized MD Quality function to oversee and ensure the quality of MD decisions across lines of business. This team will ensure rigor, consistency, transparency, and accountability in MD review processes – reinforcing our strong track record while evolving our oversight model to meet the demands of a complex and highly regulated environment.
The Executive MD Quality Lead will lead this function, serving as the clinical authority responsible for shaping the future state MD Quality operating model. This role will advance review methodology, performance calibration, and governance to ensure MD decisions remain clinically sound and aligned with enterprise standards and member-first principles.
Key Responsibilities
•Oversee governance of Aetna’s centralized MD Quality function, ensuring alignment with enterprise standards and regulatory requirements
•Lead a multidisciplinary team (Clinical and Admin Auditors, Trainers, Data Analyst, and Program Ops Manager) to strengthen audit rigor and consistency in MD reviews
•Analyze decision trends and variability to ID high-impact areas for targeted improvement
•Evaluate audit methodologies and insights to ensure findings are actionable, defensible, and aligned with priorities
•Lead MD Quality forums to set standards and drive transparency and cross-LOB alignment
•Prioritize quality improvement and remediation efforts, focusing on highest-impact interventions
•Oversee tracking of quality metrics and outcomes to ensure accountability and sustained improvement at individual and team levels
•Represent MD Quality in executive forums, providing updates on performance trends, risks, and mitigation strategies
•Serve as a trusted clinical advisor, advancing a culture of quality, rigor, and accountability
•Own cross-functional partnership with ACS, driving E2E alignment and quality improvement
Required Qualifications
•10+ years of clinical experience with progressive leadership in utilization management, medical policy, clinical operations, or quality oversight
•Experience leading clinical quality review or MD performance calibration
•Deep understanding of clinical coverage determinations, appeals, regulatory standards (e.g., CMS, NCQA), and medical necessity criteria
•Experience developing structured training programs to improve performance
•Demonstrated ability to influence senior clinical and business leaders in a complex, matrixed organization
•Strong analytical skills, including interpretation of variability metrics, IRR results, and audit findings
•Executive presence and communications skills, with experience presenting to senior leadership
Preferred Qualifications
•Experience designing/transforming internal clinical quality or audit programs
•Direct experience IRR methodology and performance calibration frameworks
•Familiarity with multiple lines of business (Commercial, Medicare, Medicaid)
•Background in change management or leading enterprise-wide quality improvement initiatives
Education
Board certified MD or DO required; training in healthcare quality, public health, health policy, or healthcare administration
Pay Range
The typical pay range for this role is:
$227,630.00 - $490,280.00
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.