Sr. Clinical Solutions MD, Commercial Clinical 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.

Job Purpose and Summary:

Join a mission-driven organization at a transformative moment in U.S. health care. As Senior Medical Director, Commercial Clinical Strategy at Aetna, a CVS Health company, you will serve as a key physician leader for Aetna's Commercial (employer group) business, responsible for defining and advancing our clinical strategy across our most critical conditions and member populations.

Reporting directly to the Vice President, Chief Medical Officer, Commercial & Innovation, and working in close partnership with senior leaders across Medical Affairs, Medical Economics, Analytics, Clinical Operations, Commercial Product, and Network, this role sits at the center of how Aetna translates clinical insight into measurable business and health outcomes for tens of millions of Commercial members.

The Senior Medical Director, Commercial Clinical Strategy will be responsible for pinpointing the failure points across the member journey that drive poor outcomes and excess costs, sizing the clinical and financial opportunity of closing those gaps, then developing, prioritizing, and sequencing interventions across all available levers into a multi-year roadmap.

We are seeking a bold, analytically rigorous physician executive who can operate at the intersection of clinical medicine, population health, and business strategy. The ideal candidate brings a proven track record of designing and scaling clinical strategies that elevate quality of care, affordability, and the member experience.

Primary Job Duties & Responsibilities:

• Build and maintain rigorous, evidence-based clinical strategies for each priority condition area (e.g. Musculoskeletal, Oncology, Maternity, Cardiometabolic disease) and priority populations (e.g. high-cost claimants, high-cost drug utilizers, and other longitudinally complex populations as identified through data analysis)

• For each priority area, identify and map the key failure points across the member journey — clinical, behavioral, and structural — that drive poor outcomes and excess costs

• Collaborate with Medical Economics and Analytics colleagues to build rigorous, bottoms-up opportunity models that quantify the clinical and financial value of closing identified gaps

• Work across utilization management, care management, benefit design, product, pharmacy, and network to identify interventions and solutions to close identified gaps

• Prioritize interventions based on expected impact and implementation feasibility; develop clear decision criteria and recommendations for leadership investment and resource allocation

• Translate prioritized strategies into sequenced, multi-year roadmaps with clear milestones, owners, dependencies, and success metrics

• Collaborate with Medical Affairs and Clinical Operations colleagues driving cross-line-of-business clinical innovation “care model” activities to ensure alignment to Commercial clinical strategy and leverage shared resources and expertise to move forward Commercial initiatives

• Represent the Commercial Medical Affairs team in product development, benefit design, and vendor selection processes as needed

• Contribute to employer client engagement, RFP responses, and external-facing thought leadership as needed

• Maintain active awareness of clinical innovation, health policy, competitor strategies, and market-shaping trends across priority clinical areas

Required Experience and Qualifications

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)

• Active and current medical license (MD or DO) without encumbrances in at least one U.S. state

• Board Certification including Maintenance of Certification in a specialty of the American Board of Medical Specialties (ABMS) or (AOA)

• Minimum 5 years of work experience in managed care, health plan strategy, or equivalent (commercial experience preferred)

• Proven track record developing and driving clinical strategies that deliver measurable cost and quality outcomes

• Strong analytical skills with demonstrated ability to build and interpret complex health care cost, quality, and utilization analyses

• Exceptional stakeholder management and executive communication skills; demonstrated ability to build coalitions and drive alignment across diverse audiences

• Ability to work virtually with occasional travel for in-person meetings (up to 15%)

Preferred Experience and Qualifications:

• Advanced degree (MBA, MPH, MPP, MHA, or equivalent) preferred

• 10+ years of combined clinical and health plan, consulting, or health care strategy experience

• Strong financial acumen and experience building business cases and securing executive investment

• Prior experience in commercial/employer line-of-business clinical strategy

Education

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)

• Advanced degree (MBA, MPH, MPP, MHA, or equivalent) preferred

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.