Director, Utilization Management Innovation & Strategy

CVS Health; Rhode Island; Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Equity awards

Job summary

CVS Health is seeking a Lead Director for UM Innovation & Strategic Analysis to define and drive the strategic analysis portfolio in Aetna's Clinical Solutions. You will identify opportunities to improve clinical, operational, and financial performance through data-driven insights and digital innovation across multiple teams.

You will lead portfolio planning for Utilization Management modernization, develop business cases, and manage automation initiatives leveraging AI, NLP, and predictive

Qualifications

• 10+ years of experience leading strategic planning, business analysis, consulting, portfolio management, transformation, or innovation initiatives within healthcare, health insurance, or managed care organizations.
• Deep understanding of health plan operations including Utilization Management, Policy Management, Care Management, Quality, Compliance, Regulatory Management, Claims, and Provider Networks.
• Demonstrated experience developing and leading enterprise strategic initiatives from concept through implementation and value realization.
• Strong analytical and problem‑solving skills, including business modeling, financial analysis, data synthesis, and development of executive‑level recommendations.
• Proven success in enterprise portfolio management, strategic planning, and prioritization of complex initiatives.
• Experience with data visualization tools and advanced analytics technologies, including SQL, Python, and cloud‑based data platforms.
• Strong understanding of automation, AI‑enabled workflows, digital transformation, and technology‑driven operational improvement.
• Expertise in developing business cases, defining success metrics, and measuring return on investment for strategic initiatives.
• Strong interpersonal and communication skills with the ability to effectively influence senior leaders and key stakeholders.

Responsibilities

• Evaluate Utilization Management performance, market trends, regulatory developments, and emerging technologies to identify opportunities that improve clinical outcomes, drive operational efficiency, reduce administrative burden, and create sustainable business value.
• Lead the development of strategic analyses, business cases, and investment recommendations that shape UM strategy, prioritize transformation initiatives, and influence executive decision-making through data-driven insights and structured problem‑solving.
• Drive strategic portfolio planning for UM modernization initiatives, including opportunity assessment, prioritization, resource alignment, funding recommendations, and value realization tracking.
• Partner with Clinical Operations, Product, Technology, and Enterprise Innovation teams to define and execute a multi‑year Utilization Management modernization roadmap aligned to business priorities and customer needs.
• Lead the identification, evaluation, and implementation of automation opportunities across UM leveraging AI, Generative AI, predictive analytics, NLP, business rules engines, and decision support technologies.
• Develop and monitor KPIs, dashboards, and performance measurement frameworks to quantify the impact of automation and transformation initiatives on productivity, service levels, quality outcomes, provider and member experience, and operating costs.
• Provide strategic oversight and governance for innovation pilots, proof‑of‑value assessments, and transformation initiatives to ensure scalability, business alignment, and achievement of targeted outcomes.
• Build influential relationships across the organization and serve as a trusted advisor to senior leaders on UM strategy, operational performance, automation opportunities, and enterprise transformation priorities.
• Manage and develop a high‑performing team through coaching, mentoring, and professional development while fostering a culture of innovation, accountability, and continuous improvement.

Skills

Strategic planning

Business analysis

Portfolio management

Transformation

Innovation initiatives

Data visualization

SQL

Python

Cloud data platforms

AI automation

Generative AI

NLP

Executive-level recommendations

Stakeholder influence

Education

Bachelor's Degree or equivalent work experience

Master's Degree preferred

Tools

SQL

Python

Cloud data platforms

Job description

CVS Health is seeking a Lead Director for UM Innovation & Strategic Analysis to define and drive the strategic analysis portfolio in Aetna's Clinical Solutions. You will identify opportunities to improve clinical, operational, and financial performance through data-driven insights and digital innovation across multiple teams.

You will lead portfolio planning for Utilization Management modernization, develop business cases, and manage automation initiatives leveraging AI, NLP, and predictive